Purpose
To evaluate the impact of full correction versus under correction on the magnitude of the myopic shift and postoperative visual acuity after unilateral intraocular lens (IOL) implantation in children.
Design
Retrospective case control study
Methods
The medical records of 24 children who underwent unilateral cataract surgery and IOL implantation at 2 to <6 years of age were reviewed. The patients were divided into two groups based on their 1 month postoperative refraction: Group 1 (full correction) −1.00 to +1.00 D; and Group 2 (under correction) ≥+2.00 D. The main outcome measures included the change in refractive error per year and visual acuity for the pseudophakic eyes at last follow-up visit. The groups were compared using the independent groups t-test and Wilcoxon rank-sum test.
Results
The mean age at surgery (Group 1, 4.2 ± 0.9 years, n=12; Group 2, 4.5 ± 1.0 years, n=12; p=0.45) and mean follow-up (Group 1, 5.8 ± 3.7 years; Group 2, 6.1 ± 3.5 years; p=0.69) were similar for the two groups. The change in refractive error (Group 1, −0.4 ± 0.5 D/yr; Group 2, −0.3 ± 0.2 D/yr; p=0.70) and last median logMAR acuity (Group 1, 0.4; Group 2, 0.4; p=0.54) were not significantly different between the two groups.
Conclusions
We did not find a significant difference in the myopic shift or the postoperative visual acuity in children aged 2 to <6 years of age following unilateral cataract surgery and IOL implantation if the initial postoperative refractive error was near emmetropia or undercorrected by 2 diopters or more.
Purpose: To investigate the role of preoperative biometry for selecting initial contact lens power.
Methods: Patients randomized to receive contact lenses in the Infant Aphakia Treatment Study (IATS) were retrospectively analyzed. Inclusion criteria were availability of both a preoperative immersion axial length measurement and a 1-month postoperative refractive value. The target contact lens power for distance was determined using 1-month postoperative spherical equivalent refraction (after adjusting for a vertex distance) over the known contact lens power. We compared targeted contact lens power for distance with three other treatment techniques: (1) 30 D contact lens (32 D minus 2 D overcorrection for near vision based on IATS protocol); (2) regression-estimated contact lens power of 84.4 - 3.2 × axial length; and (3) IOL power calculated using the Sanders-Retzlaff-Kraff (SRK/T) regression formula with a modified A-constant (112.176). Prediction error (targeted minus estimated contact lens power) and its absolute values were calculated.
Results: A total of 34 eyes of 34 patients met inclusion criteria. Age at the time of cataract surgery was 2.4 ± 1.7 months. Follow-up refraction was performed at 31 ± 3 days after surgery. Target contact lens power for distance was 26.0 ± 4.5 D for the IATS cohort (which excluded infants with corneal diameter <9 mm). The mean prediction error was -4.0, -1.0, and -2.0 D and mean absolute prediction error was 4.4, 2.2, and 2.9 D, respectively, for 30 D contact lens, regression, and SRK/T-estimated power.
Conclusions: Preoperative biometry can be used to estimate contact lens power for distance if an accurate refraction cannot be obtained initially.
Purpose: To describe a video-documented assessment of cataract type in the eyes of patients with monocular infantile cataract who were enrolled in the Infant Aphakia Treatment Study.
Methods: The Infant Aphakia Treatment Study is a randomized clinical trial in which the investigators compared intraocular lens (IOL) versus contact lens correction in 114 infants, aged 28 days to <7 months. A total of 83 videos were available for morphological analysis of cataract. Three examiners reviewed all surgical recordings and agreed on the cataract characteristics by using a score sheet to record the lens layer or configuration of the opacity.
Results: Nuclear cataract was present in 45 of 83 eyes (54%). Posterior capsule plaque was observed in 73 eyes (88%). All eyes with fetal nuclear cataract had associated posterior capsule plaque. Cortical cataract without nuclear involvement was seen in 21 eyes (25%). Posterior bowing of the posterior capsule was noted in 4 eyes (5%). Evidence of persistent fetal vasculature (PFV) was present in 18 eyes (22%). PFV was the only finding in 5 eyes but was also seen in combination with nuclear (7 eyes) and cortical cataracts (6 eyes). The entire lens was white in 3 eyes (4%), whereas the lens was partially resorbed in 7 (8%) eyes. Anterior capsule fibrosis was noted in 5 eyes with advanced cataract (1 with total cataract, 4 with partially resorbed lens).
Conclusions: Nuclear opacities were common, but many different cataract types presented in infancy. PFV occurred in isolation or in association with cataract. Posterior capsule plaque was frequently noted, especially when a nuclear cataract was present.
Purpose To report the longitudinal change in axial length (AL) from the time of unilateral cataract surgery at age 1 to 7 months to age 5 years, and to compare AL growth of operated eyes with that of fellow unoperated eyes. Design Comparative case series. Participants Infants enrolled in the Infant Aphakia Treatment Study (IATS). Methods The AL at baseline and age 5 years and change in AL were analyzed relative to treated versus fellow eye, visual outcome, and treatment modality (contact lens [CL] vs. intraocular lens [IOL] ). Eyes with glaucoma or glaucoma suspect were excluded from primary analysis but reported separately. Main Outcome Measures The AL growth from preoperative to age 5 years. Results Seventy patients were eligible; however, AL data for both eyes were available for 64 patients at baseline and 69 patients at age 5 years. The AL was significantly different between treated and fellow eyes preoperatively (18.1 vs. 18.7 mm, P < 0.0001) and at the final follow-up (21.4 vs. 22.1 mm, P = 0.0004). The difference in AL growth between treated and fellow eyes was not significant (3.3 vs. 3.5 mm, P = 0.31). The change in AL in eyes was similar with both treatments (CL 3.2 mm and IOL 3.4 mm, P = 0.53) and did not correlate with visual outcomes (P = 0.85). Eyes receiving additional surgery to clear the visual axis opacification grew significantly more compared with eyes not receiving surgery to clear the visual axis (3.8 vs. 2.7 mm, P = 0.013). Patients with glaucoma showed significantly more eye growth (5.7 mm) than those without glaucoma (3.3 mm) and glaucoma suspects (4.3 mm). Conclusions Eyes treated for monocular cataract in infancy have axial growth similar to that of fellow eyes, despite having a shorter AL at the time of surgery. The change in AL in eyes was similar with both treatments (CL and IOL), did not correlate with visual outcomes, and was higher in eyes receiving additional surgery to clear the visual axis or eyes diagnosed with glaucoma.