Strabismus surgery outcomes in the Infant Aphakia Treatment Study (TATS) at age 5 years

• Authors: Erick D. Bothun, University of Minnesota; Michael J. Lynn, Emory University; Stephen P. Christiansen, Boston University; Stacey J. Kruger, Miami, Florida; Deborah K. Vanderveen, Harvard University; Dan E. Neely, Indiana University; Scott Lambert, Emory University
• Journal Title: Journal of AAPOS
• Volume: Volume 20, Number 6
• Publisher: Elsevier | 2016-12-01, Pages 501-505
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jaapos.2016.09.014
• Subjects: Biology, Biostatistics; Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Ophthalmology; Pediatrics; INTRAOCULAR-LENS IMPLANTATION; CATARACT-SURGERY; CONGENITAL CATARACTS; PSEUDOPHAKIA; CHILDREN; COMPLICATIONS; STEREOPSIS; LIFE

Abstract

PURPOSE: To report strabismus surgery frequency and outcomes after monocular infantile cataract surgery with or without IOL implantation. METHODS: The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract. This report is a secondary outcome analysis of ocular motor data from IATS patients who underwent strabismus surgery prior to age 5 years. RESULTS: Strabismus surgery was performed in 45 (39%) patients (contact lens group [CL], 37%; IOL group, 42% [P = 0.70]). The indications for strabismus surgery were esotropia (62%), exotropia (33%), and hypertropia (4%). Infants who underwent cataract surgery at a younger age were less likely to undergo strabismus surgery (28-48 days, 12/50 [24%]; 49-210 days, 33/64 [52%]; P = 0.0037). Of the 42 patients who underwent strabismus surgery, 14 (33%) had a postoperative distance alignment within 8Δ of orthotropia at age 5 years. The 5-year visual acuity of children with strabismus was the same whether or not strabismus surgery had been performed (1.10 logMAR with surgery vs 1.00 without [P = 0.71]). CONCLUSIONS: In this study cohort, cataract surgery performed in the first 6 weeks of life was associated with a reduced frequency of strabismus surgery. Strabismus surgery outcomes in this population are guarded. Surgical improvement of strabismus does not appear to influence long-term visual acuity.