Keratometry using hand-held and automated keratometers with and without speculum in Indian pediatric cataract – A comparative study

To study the keratometry of Indian pediatric eyes, the effect of speculum on keratometry reading, the concordance of hand held and automated keratometry and the effect of unilateral and bilateral cataract on keratometry and IOL power calculation. This was conducted as a cross- sectional observational study on 101 eyes of children in the age range of 41 post-conceptional weeks to 144 months. All cooperative patients were subject to automated keratometry followed by keratometry using hand held keratometer with and without speculum. Hand held keratometer with and without speculum documented significantly increased average K as well as astigmatism and decreased calculated IOL power when compared to automated keratometry (p<0.01). No significant difference in K readings was observed between unilateral and bilateral cataracts and among males and females (p>0.05). As the age increased, astigmatism increased significantly (R=0.07; p=0.007) whereas no such correlation was observed for keratometry (p>0.05). Hand held keratometry offers the convenience of obtaining accurate keratometry, astigmatism and IOL power measurements in children.

Pre- and Post-Operative Intraocular Pressure of Pediatric Cataract Surgery

Introduction: Cataract is an eye lens opacification which prevents clear vision. It is the leading cause of blindness and vision impairment worldwide, including Indonesia. It can also be occurred in children that leads to a major cause of childhood blindness. The prevalence of childhood cataract ranges from 3 to 6 per 10,000 children. The main treatment for cataract is surgery, although pediatric cataract surgery has several complications. One of the most severe complication is glaucoma due to increased intraocular pressure (IOP). This study aimed to determine pre- and post-operative IOP in pediatric cataract surgery.Methods: This was a cross-sectional observational analytic study. Secondary data were collected from medical records of Department of Ophthalmology, Dr. Soetomo General Hospital Surabaya from January 2017 to August 2019. Age, gender, pre- and post-operative IOP, and intraocular lens implantation data were taken. Calculation was performed using the Saphiro-Wilk for data less than 50 samples. The Saphiro-Wilk test results showed that the data were normally distributed (p = 0.628). Data processing were then performed using the parametric t-pair test with a confidence level ofResults: 32 eye samples were obtained from 16 pediatric cataract surgery patients. The mean of pre-operative IOP was 13.05 mmHg and the mean of post-operative IOP was 13.36 mmHg. There was an increase in post-operative IOP with an average increase of 0.31 mmHg. There was no significant difference between pre- and post-operative IOP of pediatric cataract surgery patients (p = 0.711).Conclusion: There was no difference between pre- and post-operative IOP of pediatric cataract surgery patients at Dr. Soetomo General Hospital Surabaya for the period of January 2017 - August 2019.

Review of Corticosteroid Use in Pediatric Cataract Surgery

Introduction: Following pediatric cataract surgery, an intense inflammatory response is related to various complications, including posterior capsule opacification (PCO), which is a visually threatening incidence that can lead to visual axis opacification (VAO). Although corticosteroids are essentially effective in reducing inflammation, potential ocular side effects are a remaining concern. Objective: This study aimed to review the efficacy and safety of corticosteroid drugs and their administration routes in pediatric patients who underwent cataract surgery Methods: A literature search was conducted from four electronic databases using keywords selected a priori. Identified articles were sorted according to the type of corticosteroid used, route of administration, and outcome measures, including inflammatory response and ocular side effects. Results: Five studies were included with one case series, one retrospective case-control, and three clinical trials. The total number of subjects was 311 patients, with an age range of six weeks to 15 years old. Four studies analyzed the use of triamcinolone acetonide intracamerally, which was superior to topical steroids. Most of the studies reported a decrease in inflammatory parameters. The outcome of PCO and VAO varied between studies. Nearly all the studies observed elevated intraocular pressure (IOP) as an ocular side effect. Conclusion: Various corticosteroids and different delivery routes can be used to ameliorate inflammation in pediatric cataract surgery. However, there is promising evidence suggesting intracameral steroids as substantially beneficial in reducing inflammatory parameters. Due to the limited number of studies reviewed, no firm conclusion regarding the superior steroid preparation or route of administration can be inferred. This review highlights the need for further studies.

Limitations in cataract surgical services for children in Ethiopia: a nationwide survey of pediatric cataract surgeons

Background Bilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia. Methods A Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children (0–5 years). Results All nine responded. All but one had received either 12- or 3–5-month’s training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. The surgeons were based in seven health facilities: five in the capital (Addis Ababa) and eight in six public referral hospitals and one private center. Over 12 months (2017–2018) 508 children (592 eyes) aged 0–18 years (most < 15 years) were operated by these surgeons. 84 (17%) had bilateral cataract, and 424 (83%) had unilateral cataract mainly following trauma. A mean of 66 (range 18–145) eyes were operated per surgeon. Seventy-one additional children aged > 5 years were operated by other surgeons. There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country. Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 h. Conclusion Despite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped pediatric ophthalmology teams are urgently required, with deployment to under-served areas.

Accuracy of Intraocular Lens Power Calculation Formulas in Pediatric Cataract Patients: A Systematic Review and Meta-Analysis

Background: Among the various intraocular lens (IOL) power calculation formulas available in clinical settings, which one can yield more accurate results is still inconclusive. We performed a meta-analysis to compare the accuracy of the IOL power calculation formulas used for pediatric cataract patients.Methods: Observational cohort studies published through April 2021 were systematically searched in PubMed, Web of Science, and EMBASE databases. For each included study, the mean differences of the mean prediction error and mean absolute prediction error (APE) were analyzed and compared using the random-effects model.Results: Twelve studies involving 1,647 eyes were enrolled in the meta-analysis, and five formulas were compared: Holladay 1, Holladay 2, Hoffer Q, SRK/T, and SRK II. Holladay 1 exhibited the smallest APE (0.97; 95% confidence interval [CI]: 0.92–1.03). For the patients with an axial length (AL) less than 22 mm, SRK/T showed a significantly smaller APE than SRK II (mean difference [MD]: −0.37; 95% CI: −0.63 to −0.12). For the patients younger than 24 months, SRK/T had a significantly smaller APE than Hoffer Q (MD: −0.28; 95% CI: −0.51 to −0.06). For the patients aged 24–60 months, SRK/T presented a significantly smaller APE than Holladay 2 (MD: −0.60; 95% CI: −0.93 to −0.26).Conclusion: Due to the rapid growth and high variability of pediatric eyes, the formulas for IOL calculation should be considered according to clinical parameters such as age and AL. The evidence obtained supported the accuracy and reliability of SRK/T under certain conditions.Systematic Review Registration: PROSPERO, identifier: INPLASY202190077.