Congenital Cataract Surgery With Primary Intraocular Lens Implantation: Long-Term Refractive Status And Complications.
Published 2023 - 41st Congress of the ESCRS
Reference: FP25.05 | Type: Free paper | DOI: 10.82333/w3q5-3p96
Authors: Ana Margarida Ferreira* 1 , Inês Coelho-Costa 1 , Rodrigo Vilares-Morgado 2 , Ana Filipa Moleiro 2 , Paulo Freitas-Costa 3 , Augusto Magalhães 2
1Department of Ophthalmology,Centro Hospitalar Universitário de São João,Porto,Portugal, 2Department of Ophthalmology,Centro Hospitalar Universitário de São João,Porto,Portugal;Faculty of Medicine of the University of Porto,Department of Surgery and Physiology,Porto,Portugal, 3Department of Ophthalmology,Centro Hospitalar Universitário de São João,Porto,Portugal;Faculty of Medicine of the University of Porto,Anatomy Unit, Department of Biomedicine,Porto,Portugal
Purpose
Congenital cataract is a significant cause of visual impairment in children worldwide. Early diagnosis and treatment are essential to maintain proper development of normal visual function. We aimed to assess visual acuity and refractive status evolution over time, considering initial biometry (in diopters) and the power of the implanted intraocular lens (IOL). We also aimed to evaluate the development of complications and the need for a second surgical intervention.
Setting
Children under two years old, diagnosed with congenital cataracts and submitted to surgery with primary IOL implantation and triamcinolone-assisted anterior vitrectomy by one senior surgeon at a tertiary care Portuguese university hospital.
Methods
The medical records of 32 consecutive patients (42 eyes) who underwent surgery after 2008 and had at least two years of follow-up were reviewed retrospectively. Patients were divided into unilateral (UNI, n=22) and bilateral (BIL, n=20) cataract groups. Best corrected visual acuity (BCVA) was reported in the decimal scale. Patients with concomitant primary congenital glaucoma, anterior segment dysgenesis and secondary cataracts were excluded.
Results
Mean follow-up time was 7.28 years (range 2-13). Children in UNI were significantly younger at the time of surgery (7,95 vs 17,00 months, p<0.01). The power of the implanted IOL significantly differed between groups (26.3 UNI vs 24.1 BIL, p=0.006). 17 eyes required a second surgical intervention (12 UNI vs 5 BIL). Mean final BCVA was higher in BIL (0.56±0.24 vs 0.22±0.20, p<0.01). 86% patients in UNI received occlusion therapy for amblyopia. Four patients in UNI developed glaucoma after surgery – the only complication associated with final BCVA ≤0.1 (X2=17.45, p<0.01). There was a significant correlation between final BCVA and age at surgery (r=0.688, p<0.01) but no association with IOL calculations or myopic shift during ocular growth.
Conclusions
Primary IOL implantation in children <2 years is a safe surgical procedure. A reasonably good postoperative visual acuity was achieved in the bilateral patients but relatively worse in unilateral ones. Elevated intraocular pressure and glaucoma were the most common complications, associated with a worse visual prognosis.