Refractive Correction And Visual Outcomes In Children With Cataract Extraction Under 1 Year Of Age
Published 2024
- 42nd Congress of the ESCRS
Reference: FP10.07
| Type: Free paper
| DOI:
10.82333/140v-6611
Authors:
Alejandro Alcaide* 1
, Eva Calpe 1
, Marina García 1
, Santiago Tañá 1
, Gemma Julio 1
, Rafael Ignacio Barraquer 1
1Centro de Oftalmología Barraquer,Barcelona,Spain
Purpose
To describe the management at our institution of pediatric cataracts in children under 1 year of age, differentiating between unilateral and bilateral cases. Specifically, we aimed to evaluate the visual correction methods applied (contact lens alone or with glasses) in both groups during the period after cataract extraction (CE) and secondary intraocular lens (IOL) implantation. Furthermore, we examined the improvement of their visual acuity with these corrections and their refractive outcomes following IOL implantation.
Setting
The age at which secondary IOL should be implanted in the youngest patients is still an ongoing debate. Effective aphakia management is essential for optimal visual potential. Contact lenses are the main correction method, but challenges like tolerance and adaptability can lead to treatment failure. In this retrospective study, medical records of children with CE between 2000 and 2023 in the Centro de Oftalmología Barraquer, a tertiary referral hospital in Barcelona (Spain), were reviewed.
Methods
Ninety-eight eyes of 64 children with pediatric cataract who underwent CE at < 1 year were revised. Patients with current aphakia, primary IOL implantation, or those with ≤ 1 follow-up visit after CE were excluded. Fifty-three eyes were finally included and classified as unilateral or bilateral. Postoperative management was evaluated in each group, comparing contact lenses alone (Silsoft™) vs contact lens plus glasses. Best-corrected visual acuity (BCVA) was measured in decimal scale and converted to logMAR scale for statistical analysis. Teller test was used in the youngest cases and results were converted to logMAR scale. Functional success was defined as BCVA ≥ 0.05 (decimal scale) and was evaluated before and after IOL implantation.
Results
Twelve eyes were included in the unilateral group (mean CE time: 3.7 ± 2.6 months) and 41 in the bilateral (mean CE time: 3.4 ± 1.6) (P=0.8). All unilateral cases were corrected with contact lenses, while in the bilateral group, this percentage was of 63% (n=26), as fifteen (37%) were also treated with glasses (P=0.012). Functional success in these aphakic eyes was of 36% in unilateral vs 55% in bilateral eyes. In the last follow-up after IOL implantation (mean: 8.7 ± 4.6 years), this success improved in both groups, being 63% in unilateral and 90% in bilateral. BCVA at the last follow-up visit was 1.3 ± 0.21 logMAR (mean 0.05 decimal) in the unilateral group and 0.33 ± 0.22 logMAR (mean 0.49 decimal) in the bilateral (P<0.001).
Conclusions
Uncorrected refractive error in the early years can lead to amblyopia. Attention to appropriate refractive correction after pediatric CE is crucial to achieve optimal visual development in these children. In our institution, children with CE under 1 year of age are left aphakic usually four years due to their ocular growth. Contact lens adaptation is the preferred modality for their refractive management during aphakia, and glasses are also combined in most bilateral eyes. Contact lens adaptation can become a true challenge that can modify the predicted therapeutic approach and anticipate the age of IOL implantation. Therefore, BCVA, patching, and refractive correction must be carefully evaluated and optimized before IOL placement.