Outcomes Of Cataract Surgery In Patients With Down Syndrome

To present the outcomes of cataract surgery in patients with Down syndrome

Place of study- Dr. R.P. Centre, AIIMS New Delhi.

This retrospective case series included 44 eyes of 22 patients with Down syndrome with cataracts who underwent surgical management for visual rehabilitation at a tertiary eye care Centre. All patients with Down syndrome were operated under general anesthesia. The study adhered to the Declaration of Helsinki, and ethical clearance was obtained from the institute’s ethics committee.

The medical records of all cases were evaluated, and the following parameters were recorded: age, gender, preoperative distance visual acuity, presence of strabismus and nystagmus, cataract morphology, fundus findings, axial length, and keratometry. The patient's visual acuity was documented using age-appropriate methods and taking into account the capabilities of the children. The following parameters were recorded: age, gender, preoperative distance visual acuity, presence of strabismus and nystagmus, cataract morphology, fundus findings, axial length and keratometry. 

A careful review of surgical notes was performed to record the various intraoperative difficulties and complications. 

The mean age at the time of surgery was 10.54 ± 13.92 years (54% < 2 years), with 12 males (54%) and 10 females (46%). All patients presented with bilateral cataracts. Associated ocular problems included nystagmus (24 eyes), strabismus (5 eyes), keratoconus (16 eyes), corneal scar (2 eyes), and microcornea (2 eyes). The presenting complaints were white reflex (22 eyes, 50%), Diminution of vision (8 eyes, 18.1%), abnormal eye movements (8 eyes, 18.1%) and inward deviation (6 eyes, 13.6%). The most common cataract morphology was zonular cataract (22 eyes, 50%).

The intraoperative problems encountered included poor pupillary dilatation in six eyes (13.6%), necessitating the use of iris hooks in two eyes (4.5%).

• Cataract surgery for Down syndrome is challenging due to the associated systemic condition in these patients.
• Postoperative visual rehabilitation can be challenging due to the poor compliance of these patients.
• Ophthalmic examination within 6 months of birth in children with Down syndrome is recommended to detect any associated ocular pathology, with subsequent examination to be performed every 1-2 years.