Predictive Refractive Error Post Congenital and Developmental Cataract Surgery

Cataract is one of the leading treatable causes of visual impairment in children. Visual rehabilitation is crucial for the development of good visual function after cataract surgery in children. The research aimd to describe post-operative Predictive Refractive Error (PRE) in congenital and developmental cataracts in Cicendo National Eye Hospital from January 2017 to December 2018. This is a retrospective analytic observational study from medical records. We found 107 eyes of 62 children with congenital and developmental cataracts had had cataract surgery and primary implantation of Intraocular Lens (IOL) in Pediatric Ophthalmology and Strabismus Unit, Cicendo National Eye Hospital. The patients were divided into two groups, with axial length (AXL) of ≤ 24 mm and > 24 mm. The paired t-test was used to compare Predictive Error (PE) in SRK/T, SRK II, and Showa SRK formula. Mean age at surgery was 6.7 ± 4.0 years. Ninety-five eyes had AXL ≤ 24 mm, and 12 eyes had AXL > 24 mm. Prediction Error from patients with AXL ≤ 24 mm was 0.29 D, and from patients with AXL > 24 mm was 2.40 D in SRK/T formula (P < 0.05). There was no significant difference between PE and Absolute Predictive Error (APE) in SRK/T, SRK II, and Showa SRK in patients with AXL > 24 mm (P > 0.05). SRK/T is the most predictable formula in patients with AXL ≤ 24 mm. There is no significant difference in patients with AXL > 24 mm in all formulas. Keywords: congenital and developmental cataract, axial length, Prediction Error, intraocular lens

Congenital and developmental cataract surgery with undercorrected Intraocular lens (IOL) power implantation targeting emmetropia at 8 years of age and post-operative refractive status

Background: In congenital and developmental cataract primary undercorrection of intraocular lens (IOL) power is a common practice. However, long-term refractive status of these children is largely unknown. Aims and Objective: To analyse refractive status after cataract surgery with undercorrected IOL power implantation in congenital and developmental cataract. Materials and Methods: This study was descriptive, retrospective conducted for three years from 1st January 2013 to 31st December 2015. The children (> 6 months to <=7 years of age) who underwent cataract surgery for congenital and developmental cataract with a primary IOL implantation and had reached the age of 8 years were studied. The data were collected in terms of demography, axial length, biometry, IOL implanted, hyperopic correction and postoperative refractive status at 8 years. Results: Total numbers of children operated were 181 with total eyes 288. Unilateral cases were 74 (40.88%) and bilateral 107 (59.12%). Male were 121 (66.85%) and female were 60 (33.15%) with male is to female ratio of 2:1. Right eye was involved in 152 (52.8%) and left eye 136 (47.2%). The mean axial length at the age of one year was 20.75 mm, and gradually increased as age increased which was 22.47 mm at 6 years. The mean biometry was 27.9 diopter (D) at the age of one year which gradually decreased as age increased. Of the total 288 congenital cataract operated, complete follow-up documents were available for 77 (26.74%) eyes up to 8 years which showed emmetropia achieved in 25.97%, myopia in 28.57% and hypermetropia in 45.45%. Conclusion: Primary IOL implantation with hyperopic correction is accepted practice in congenital and developmental cataract. Emmetropia can be achieved however some hyperopic or myopic refractive status at the age of 8 years is not a surprise. Myopic shift continues as the age increases. Parent awareness for early detection and surgery, optical correction and regular follow-up are essential for good outcome.

The Size-Weight Illusion is unimpaired in individuals with a history of congenital visual deprivation

Visual deprivation in childhood can lead to lifelong impairments in visual and multisensory processing. Here, the Size-Weight-Illusion was used to test whether visuo-haptic integration recovers after sight restoration. In Experiment 1, congenital (CC: 7 (3F), 8–35 years) and developmental cataract reversal individuals (DC: 9 (2F), 8–37 years), as well as congenitally blind (CB: 2 (1F), 33 and 44 years) and normally sighted individuals (SC: 10 (7F), 19-36 years) perceived larger objects as lighter than smaller objects of the same weight. In Experiment 2, CC (6 (1F), 17–44.7 years) and SC (7 (5F), 21-29 years) individuals performed identically when tested without haptic size cues. Together, this suggested that early visual experience is not necessary to perceive the Size-Weight-Illusion.

Analysis of corneal astigmatism and aberration in chinese congenital cataract and developmental cataract patients before cataract surgery

Background To investigate the distribution of corneal astigmatism, aberration, and biometric parameters in Chinese congenital cataract (CC) /developmental cataract patients before cataract surgery. Methods We evaluated eyes of CC /developmental cataract patients scheduled for cataract surgery from January 2016 to September 2019. Astigmatism, aberrations, and biometric parameters were measured with the Pentacam Scheimpflug imaging device (Pentacam HR, Oculus). Cataract was diagnosed and classified by slit-lamp examination after full mydriasis. Results We evaluated 538 eyes in 356 patients. The mean values of anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), and total corneal astigmatism (TCA) were determined as 1.98 ± 1.06 D (range 0.0‒4.8 D), 0.49 ± 0.26 D (range 0.0‒1.9 D), and 2.09 ± 1.19 D (range 0.2‒8.8 D), respectively. ACA and TCA ≥ 1.25 D was present in 379 eyes (70.3%) and 392 eyes (72.8%), respectively. PCA between 0.25 D and 0.75 D was found in 380 eyes (70.6%). There was a statistically significant positive linear correlation between lower-order aberrations root mean square values (LOA RMS) and corneal astigmatism (CA). Furthermore, in terms of distribution of central cornea thickness, anterior chamber depth, ACA, PCA, and TCA in different types of cataracts, ACA was highest in patients with zonular cataracts. Finally, we found anterior corneal measurements may overestimate WTR astigmatism, underestimate ATR astigmatism, and underestimate oblique astigmatism, respectively. Conclusions Most CC /developmental cataract patients had moderate to high astigmatism and ACA accounted for the largest proportion in the zonular group. This can provide a basis for planning of CC/developmental cataract surgery by ophthalmologists in clinical practice.

Profil Kekeruhan Kapsul Lensa Posterior Pasca-Operasi Katarak Developmental

Abstract-Visual Rehabilitation optimization is the main goal of cataract management in children. To achieve the optimum vision development, cataract management in children does not come to an end by the time a cataract surgery is performed. In most cases, problems occurring in vision rehabilitations include posterior capsule opacifications in post-surgery children cataract patients. Objective To know the profile of posterior capsule opacification in developmental cataract surgeries of children (aged 5-18) at Cicendo National Eye Hospital in January-December 2016. Method: The design of this study is observational retrospective study using medical records of post-operative developmental cataracts patients with intra ocular lens implantations with inclusion and exclusion criteria. The procedures were performed on 74 eyes in 47 patients. Results: Posterior capsule opacification (OPC) occurred in 41 (55.4%) eyes, detected in week 1-36 post-op. In week 0-6 post-op, OPC occurred the most to the tune of 13 (31.7%) eyes with dominating age group of under 9 years old to the tune of 29 (68.3%) eyes. Conclusion: PCO shows a tendency of occurring more in younger patients. Factors which affect PCO include complications, e.g. eye abnormalities, the relating systemic abnormalities, surgery techniques, and inaccurate selection of intra-ocular lens. Keywords: developmental cataract, posterior capsul opacification Abstrak-Tujuan utama penanganan katarak anak adalah optimalisasi rehabilitasi penglihatan. Untuk mencapai perkembangan yang optimal, penalataksanaan katarak anak tidak berhenti pada operasi saja. Potensi hambatan optimalisasi rehabilitasi penglihatan adalah seringnya terjadi kekeruhan kapsul lensa posterior. Penelitian ini bertujuan untuk mengetahui profil kekeruhan kapsul lensa posterior pasca-operasi katarak developmental anak usia 5-18 tahun di Pusat Mata Nasional Rumah Sakit Mata Nasional Cicendo antara Januari-Desember 2016. Penelitian dilakukan secara retrospektif observasional melalui rekam medik pasien katarak developmental anak usia 5-18 tahun yang dilakukan operasi katarak dan implantasi LIO pada bulan Januari-Desember 2016 dengan kriteria inklusi dan eksklusi yang telah ditetapkan. Hasil menunjukkan terdapat 47 anak, 74 mata dengan diagnosis katarak developmental telah dilakukan operasi katarak dan penanaman LIO. Pasca-operasi didapatkan 41 (55.4%) mata mengalami PCO, terdeteksi pertama kali minggu ke-1-36 pasca-operasi, terbanyak pada minggu ke-0-6 pasca-operasi yaitu 13 (31.7%) mata. Kelompok usia terbanyak di bawah 9 tahun yaitu 29 (68.3%) mata. Simpulan penelitian ini adalah semakin muda usia saat dioperasi, semakin cepat timbul PCO. Faktor yang mempercepat timbulnya PCO lainnya adalah penyakit lain yang menyertai, seperti kelainan lain pada mata, kelainan sistemik yang menyertai, teknik operasi dan pemilihan LIO yang kurang tepat. Penatalaksanaan PCO adalah Nd:YAG Laser dan kapsulotomi posterior sekunder. Kata kunci: katarak developmental, PCO

A Rare Case report of Ichthyosis Follicularis, Alopecia and Photophobia (IFAP) Syndrome with developmental cataract

Purpose: The IFAP syndrome is a rare X-linked genetic disorder with only 40 reported cases worldwide. We report a 23 year old, male patient with classical IFAP syndrome. Method: Descriptive single case report. Case: 23 years old male patient, presented with ocular findings of photophobia, cornealinfiltrate, superior corneal vascularization and astigmatism along with dermatological manifestations. Result: Photophobia was pathognomonic in a patient presenting with Icthyosisfollicularis and alopecia. Associated ocular findings were corneal infiltrate, superior corneal vascularization, angio regression with pericytic infilterate and Astigmatism. Our patient also presented with bilateral developmental cataract. Conclusion: Developmental cataract can be a primary manifestation with IFAP syndrome. Corneal infiltrates with photophobia as the only presenting symptom can be a rare finding associated with rare skin disorders like IFAP syndrome. They are also the most challenging symptoms to manage.

Visual outcome of congenital and developmental cataract surgery in Lumbini Eye Institute

Background: Paediatric blindness presents as an enormous problem to developing countries in terms of human morbidity, economic loss and social burden.Aims and Objective: The objective of this study was to observe the visual outcome of congenital and developmental cataract surgery.Materials and Methods: This study was prospective, longitudinal and interventional. The patients aged ≤15 years, diagnosed either congenital or developmental cataract and planned for cataract surgery were enrolled during March 2014 to February 2015 at Lumbini Eye Institute, Nepal. The patients underwent either: a) Lens aspiration + PPC+ Anterior Vitrectomy; b) Lens aspiration + PPC+ Anterior Vitrectomy + PCIOL; c) Lens Aspiration + PCIOL depending upon age of patient. The patients were examined after surgery day 1, day 2, after 2 weeks and after 6 weeks. Glasses were prescribed at 6 weeks from the date of surgery. Occlusion therapy was initiated in cases wherever necessary.Results: A total of 54 eyes of 43 children were included in the study. The sex ratio was 1.26 female per male with mean age of 3 years (SD ± 2.16). In the verbal group, 61.1% (33 eyes) had final visual acuity (6/6-6/18). In the non verbal group, 16.7% (9 eyes) had final visual acuity of good fixation and follow. There was a statistically highly significant improvement in post surgical Best corrected visual acuity (p< 0.001).Conclusion: Good visual outcome after pediatric cataract surgery can be obtained if surgery is performed by skilled surgeon. The awareness of pediatric cataract, early diagnosis and timely intervention to surgical treatment, and postoperative management of residual uncorrected refractive error and amblyopia are important factors for the prevention of childhood blindness from cataract.Asian Journal of Medical Sciences Vol.9(2) 2018 36-39

Follow-up patterns and associated risk factors after paediatric cataract surgery: observation over a 5-year period

PurposeTo study the pattern of compliance to follow-up of children less than 5 years of age undergoing surgery for congenital and developmental cataract over a period of 5 years.MethodsIt is a retrospective study of children less than 5 years of age undergoing cataract surgery between January and December 2010 for congenital or developmental cataract and followed up until 31 December 2015. Age, sex, distance from hospital and urban or rural habitat, delay in presentation, socioeconomic status, laterality, morphology and type of cataract, implantation of intraocular lens and interventions done were noted. Compliance to follow-up at postoperative 1 week, 1 month, 3 months, 6 months, 1 year and then once a year until 5 years were recorded.Results169 patients were included in the study. The median follow-up was 22 months. Median age at surgery was 10 months and had a negative correlation with total follow-up. Male-to-female ratio was 1.82. Logarithmic curve of follow-up was noticed with 85%, 61%, 55%, 52%, 39% and 28% patients attending 1 month, 3 months, 6 months, 1 year, 3 years and 5 years of follow-up, respectively. Low socioeconomic group had poor follow-up compared with higher socioeconomic group (P=0.009), but the curve of follow-up was similar in both groups; multiple interventions group had better follow-up (P<0.0001).ConclusionCurve of loss to follow-up is logarithmic in children undergoing paediatric cataract surgery. Age at surgery and low economic status are the most important factors associated with poor follow-up.