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A long-term longitudinal assessment of postoperative outcomes after congenital cataract surgery in children with congenital rubella syndrome
Session Title: Paediatric Cataract Surgery
Session Date/Time: Monday 07/10/2013 | 16:30-18:00
Paper Time: 16:30
Venue: Forum (Ground Floor)
First Author: : S.Shah INDIA
Co Author(s): : R. Ristovski M. Praveen V. Vasavada V. Vasavada A. Vasavada S.
To evaluate intraoperative performance and long-term postoperative outcomes after cataract surgery in children with congenital rubella syndrome (CRS).
Iladevi Cataract and IOL Research Centre, Ahmedabad, India.
A prospective interventional case series comprising 37 eyes of 21 children with CRS who underwent cataract surgery. Microcornea was defined as a horizontal corneal diameter less than or equal to 9 mm. A standardized surgical technique was followed throughout the study. All microphthalmic eyes were left aphakic. A single-piece hydrophobic acrylic IOL was implanted inside the capsular bag in eyes without microphthalmos. Intraoperative complications were documented. All children were followed up every 6 months upto 5 years postoperatively. The postoperative observations documented at every follow-up were posterior synechiae, visual axis obscuration (VAO), glaucoma, and other complications. Complete orthoptic and visual assessment was also performed at each postoperative visit.
The mean age of 21 children was 3.97±2.1 months. All eyes completed 5 years followup. None of the eyes had major intraoperative complications. IOL implantation was performed in 12 (32.4%) eyes while 25 (67.6%) eyes were left aphakic. At final followup, posterior synechiae were seen in 22 (59.5%) eyes, VAO in 9 (24.3 %) eyes of which 6 eyes underwent secondary procedure, secondary glaucoma in 16 (43.2 %) eyes of which 14 eyes were aphakic while 1 eye pseudophakic. Of these 14 aphakic eyes, 8 eyes had microphthalmos with microcornea and 9 eyes required trabeculectomy for control of glaucoma. A statistically significant impact of age at surgery and associated ocular comorbidity was documented for secondary glaucoma (chi-square test (x2 < 0.05) and Kendalls Tau-B criteria (p < 0.05)). Mean visual acuity at final follow up (LogMAR) was 0.72±0.56.
The long-term results suggest good visual outcomes can be obtained following congenital cataract after early surgical intervention in eyes with congenital rubella syndrome with an acceptable rate of serious postoperative complications.