Purpose: We report endothelial cell (EC) characteristics and central corneal thickness (CCT) from Infant Aphakia treatment Study (IATS) patients at the 5-year exam.
Design: Randomized, controlled trial of the treatment of unilateral cataract with aphakic contact lens (CL) versus primary intraocular lens implant (IOL).
Subjects: 114 infants with unilateral cataract.
Methods: EC density, coefficient of variation (CV), and percent hexagonal cells were measured by non-contact specular microscopy. Central corneal thickness (CCT) was measured using contact pachymetry. Fellow eyes served as controls.
Main outcome measures: Mean differences between treated and fellow eyes of CL and IOL groups were compared with a paired t test. A one-way analysis of variance model and the Tukey-Kramer multiple comparison procedure were used to assess the effect of a diagnosis of glaucoma or glaucoma suspect.
Results: 105 (52 CL, 53 IOL) had either specular microscopy or corneal thickness data recorded. Mean EC densities were higher in the aphakic eyes compared to fellow eyes (3921 and 3495 cells/mm2, p < 0.0001). Mean CV was higher in aphakic eyes (27 vs 24, p=0.0002), and mean percent hexagonal cells was lower (72% vs 76%, p=0.002). Mean CCT of aphakic eyes was higher than controls (637 vs 563 μm, p < 0.0001). There was no difference in EC densisty in eyes treated with IOL compared to fellow eyes (3445 and 3487 cells/mm2, p=0.68). Means for CV (25 vs 24, p=0.07) and percent hexagonal cells (74 vs 76%, p=0.27) were also not significantly different. Mean CCT was higher in eyes with IOL (605 vs 571 μm, p < 0.0001) compared to fellow eyes. Compared to treated eyes without glaucoma or glaucoma suspect, treated eyes with glaucoma had lower EC density (3289 vs 3783 cells/mm2, p = 0.03) and treated eyes with glaucoma suspect had greater mean corneal thickness (660 vs 612 μm, p = 0.0036).
Conclusion: Cataract extraction during infancy with IOL implantation was not associated with a reduced EC count in treated compared to fellow eyes, although CCT was increased. Extended wear aphakic CL may cause corneal polymegathism with increased EC density and CCT. Glaucoma diagnosis was associated with reduced EC counts and increased CCT.
We read with the interest the article by Cao et al. reporting spectacle wear adherence in aphakic children after bilateral cataract surgery. In their series, spectacle adherence was only 31% during the first year of life. Poor spectacle adherence during these formative years when central visual pathways are developing puts these children at risk for life-long visual disability. In contrast, contact lens adherence was much higher during the first year of life among participants in the Infant Aphakia Treatment Study (IATS) a multicenter, longitudinal, randomized clinical trial in the United States, which randomized infants after unilateral cataract surgery to primary intraocular lens (IOL) implantation or aphakia.
Purpose: To evaluate an alternative retinopathy of prematurity (ROP) screening system that identifies infants meriting examination by an ophthalmologist in a middleincome country. Methods: The authors hypothesized that grading posterior pole images for the presence of pre-plus or plus disease has high sensitivity to identify infants with type 1 ROP that requires treatment. Part 1 of the study evaluated the feasibility of having a non-ophthalmologist health care worker obtain retinal images of prematurely born infants using a non-contact retinal camera (Pictor; Volk Optical, Inc., Mentor, OH) that were of sufficient quality to grade for pre-plus or plus disease. Part 2 investigated the accuracy of grading these images to identify infants with type 1 ROP. The authors prospectively recruited infants at Chulalongkorn University Hospital (Bangkok, Thailand). On days infants underwent routine ROP screening, a trained health care worker imaged their retinas with Pictor. Two ROP experts graded these serial images from a remote location for image gradability and posterior pole disease. Results: Fifty-six infants were included. Overall, 69.4% of infant imaging sessions were gradable. Among gradable images, the sensitivity of both graders for identifying an infant with type 1 ROP by grading for the presence of pre-plus or plus disease was 1.0 (95% confidence interval [CI]: 0.31 to 1.0) for grader 1 and 1.0 (95% CI: 0.40 to 1.0) for grader 2. The specificity was 0.93 (95% CI: 0.76 to 0.99) for grader 1 and 0.74 (95% CI: 0.53 to 0.88) for grader 2. Conclusions: It was feasible for a trained non-ophthalmologist health care worker to obtain retinal images of infants using the Pictor that were of sufficient quality to identify infants with type 1 ROP.
Purpose: To evaluate (1) the feasibility of nonophthalmologist healthcare workers (HCWs) obtaining images of sufficient quality for retinopathy of prematurity (ROP) screening using a Food and Drug Administration-approved portable, noncontact, narrow-field fundus camera (i.e., Pictor; Volk Optical, Inc, Mentor, OH) and (2) the accuracy of grading these images to identify infants in whom treatment-warranted (type 1) ROP developed.
Design: Prospective cohort study. Participants: Infants undergoing routine ROP screening examinations (i.e., birth weight ≤1500 g, gestational age ≤30 weeks, or both, or selected infants with a birth weight of 1500–2000 g or gestational age >30 weeks and an unstable clinical course).
Methods: We prospectively recruited infants undergoing ROP screening examinations at a community hospital. On the same day an ophthalmologist examined them, a trained HCW imaged their retinas using the noncontact camera. Two masked ROP experts graded these images remotely. We calculated both the percentage of gradable images (i.e., having at least 3 quadrants with sufficient image quality), as well as the accuracy of identifying infants in whom type 1 ROP developed. Main Outcome Measures: Percentage of gradable images and the sensitivity and specificity of each grader for identifying infants with type 1 ROP by grading for the presence of preplus or plus disease.
Results: Ninety-nine infants were included. Overall, 92.4% and 94.2% of all infant imaging sessions were considered gradable by graders 1 and 2, respectively. Among gradable images, the sensitivity of both graders for identifying type 1 ROP by grading for the presence of preplus or plus disease was 100% (95% confidence interval [CI], 95%–100%), and the specificity was 91% (95% CI, 83%–95%) for grader 1 and 93% (95% CI, 86%–96%) for grader 2.
Conclusions: It was highly feasible for trained HCWs to obtain digital retinal images of sufficient quality for ROP screening using a noncontact fundus camera. By grading for the presence of preplus or plus disease, graders identified infants in whom type 1 ROP developed with high sensitivity and specificity. The use of portable, noncontact retinal cameras by trained HCWs could increase our workforce in ROP screening and identify infants needing indirect ophthalmoscopy examinations by an ophthalmologist.
Objective
To report the incidence of glaucoma and glaucoma suspects in the Infant Aphakia Treatment Study (IATS). To evaluate risk factors for the development of a glaucoma-related adverse event in IATS in the first year of follow-up.
Methods
114 infants with a unilateral congenital cataract were assigned to undergo cataract surgery between 1 to 6 months of age either with (IOL) or without IOL implantation (CL). Standardized definitions of glaucoma and glaucoma suspect were created and used in the IATS.
Results
Ten patients (9%) developed glaucoma and 4 patients (4%) were glaucoma suspects for a total of 14 patients (12%) with a glaucoma-related adverse event in the treated eye through the first year of follow-up. Five CL patients (9%) and 9 IOL patients (16%) developed a glaucoma-related adverse event. The odds of developing a glaucoma-related adverse event was 3.1 times higher for a child with persistent fetal vasculature (PFV), and 1.6 times higher for each month of age younger at cataract surgery.
Conclusions
Modern surgical techniques do not eliminate the early development of glaucoma following congenital cataract surgery with or without an intraocular lens. Younger patients with or without PFV seem more likely to develop a glaucoma-related adverse event in the first year of follow-up.Vigilance for the early development of glaucoma is needed following congenital cataract surgery, especially when surgery is performed during early infancy or with PFV. Five year follow-up data for the IATS will likely reveal more glaucoma-related adverse events.