Complications of pediatric cataract surgery and intraocular lens implantation

PURPOSE: To study the pattern of postoperative complications following extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in pediatric eyes. SETTING: Tertiary eye care center, New Delhi, India. METHODS: A retrospective analysis of 39 eyes of 28 children referred for complications after ECCE with IOL implantation was performed. The results evaluated were visual acuity, iridocapsular problems, and IOL-related complications. Additional interventions such as neodymium:YAG (Nd:YAG) capsulotomy, surgical membranectomy, and penetrating keratoplasty (PKP) were done when necessary. Visual acuity was measured 1 week following intervention and at the last follow-up. RESULTS: Congenital (17 eyes, 43.6%), developmental (11 eyes, 28.2%), and traumatic (11 eyes, 28.2%) cataract were the indications for surgery. Posterior capsule opacification (34 eyes, 87.2%), updrawn pupil (15 eyes, 38.5%), decentered IOL (13 eyes, 33.3%), and pupillary capture (12 eyes, 30.8%) were the major complications. An Nd:YAG capsulotomy was attempted in 19 eyes (48.7%). Surgical membranectomy was performed in 10 eyes (25.6%); PKP was performed in 2 eyes (5.1%) to treat pseudophakic bullous keratopathy. One eye had to be eviscerated because of uncontrolled endophthalmitis. In 31 eyes in which visual acuity could be measured, 27 had an acuity of 6/60 or worse at the time of presentation. Following intervention and amblyopia therapy, 19 eyes achieved a visual acuity of 6/18 or better. CONCLUSION: Routine ECCE with IOL implantation in pediatric eyes is associated with various problems and may lead to permanent visual disability.     

Multifocal intraocular lens implantation in patients with traumatic cataract

OBJECTIVE: To evaluate the postoperative outcome and complication rate of cataract extraction with implantation of a zonal-progressive multifocal intraocular lens (IOL) for traumatic cataract. DESIGN: Prospective, nonrandomized, comparative trial. PARTICIPANTS: Fifty-one eyes of 51 subjects with traumatic cataract caused by nonpenetrating, penetrating, and perforating ocular trauma at two university institutions with more than 12 months follow-up. INTERVENTIONS: Temporal clear corneal phacoemulsification with foldable IOL implantation was performed in all eyes. In 29 subjects, a zonal-progressive optic multifocal IOL (Array SA40-N Allergan, Irvine, CA) was implanted, whereas 22 subjects received a monofocal IOL and served as controls. RESULTS: Preoperative subjects demographics, mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuity were similar in the two groups. Subjects with a multifocal IOL achieved a significantly better uncorrected near visual acuity than subjects with monofocal IOL (0.24 vs. 0.40; P = 0.0001). With distance correction only, mean near visual acuity was 0.21 vs. 0.43 (P = 0.0001). Best-corrected near visual acuity was 0.17 for both groups (P = 0.91), with +1.24 diopters (D) for the multifocal group and +2.45 D for the monofocal group (P = 0.0001). Spectacle dependency differed significantly between the two groups, with 18 (81%) subjects of the monofocal group commonly requiring an additional plus add for near tasks compared with 5 (17%) subjects in the multifocal group (P = 0.001). Stereopsis was superior in the multifocal group (P < 0.001), with 20 (69%) and 16 (55%) patients with a multifocal IOL responding positively to the Lang and Titmus tests, respectively. In the monofocal group, only eight (36%) and five (22%) subjects gave correct answers. CONCLUSIONS: Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in subjects with traumatic cataract.     

Multifocal intraocular lens implantation in prepresbyopic patients with unilateral cataract

OBJECTIVE: To evaluate the benefits of implantation of a zonal-progressive multifocal intraocular lens (IOL) in prepresbyopic patients with unilateral cataract. STUDY DESIGN: Prospective, nonrandomized, comparative trial. PARTICIPANTS: Ninety-five eyes of 95 prepresbyopic patients aged between 14 and 40 years with either multifocal or monofocal IOL implantation at two institutions and with more than 6 months follow-up. INTERVENTIONS: Temporal clear corneal phacoemulsification and foldable IOL implantation was performed in all eyes. In 54 patients, a zonal-progressive optic multifocal IOL (Array SA40-N, Allergan, Irvine, CA) was implanted, whereas 41 patients received a monofocal IOL and served as controls. RESULTS: Preoperative patient demographics, mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuities were similar in the two groups. Patients with a multifocal IOL achieved a significantly better uncorrected near visual acuity than patients with monofocal IOL (0.18 versus 0.37; P = 0.0001). With distance correction only, mean near visual acuity was 0.17 versus 0.43 (P = 0.0001). Best-corrected near visual acuity was 0.11 for both groups (P = 0.91), with +1.43 diopters (D) for the multifocal group and +2.35 D for the monofocal group (P = 0.0001). Spectacle dependency differed significantly between the two groups, with 21 patients (51%) of the monofocal group commonly requiring an additional plus add for near tasks compared with 5 patients (9%) in the multifocal group (P = 0.001). Stereopsis was superior in the multifocal group (P < 0.001), with 42 (77%) and 33 (61%) patients with a multifocal IOL responding positively to the Lang and Titmus tests, respectively. In the monofocal group; only 20 (48%) and 9 (22%) patients gave correct answers. CONCLUSIONS: Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in prepresbyopic patients with unilateral cataract.     

散光人工晶状体在白内障摘除手术中的应用

散光人工晶状体（Toric IOL）是将散光矫正与人工晶状体的球镜度数相结合的一种新型屈光性人工晶状体。利用这种人工晶状体矫正角膜散光是一种合理的、可预测性强、术后效果更加稳定的屈光矫正方式。目前在临床上应用较多的Toric IOL主要有AA4203TF、AA4203TL，MicrOSi16116TU，Acrysof SN60TF，Acri．Smart 646TLC等四种。其主要问题有人工晶状体的术后旋转导致矫正能力下降甚至产生新的散光等。本文就Toric IOL在白内障摘除手术中的应用作一综述。     

Refractive accuracy after intraocular lens implantation in pediatric cataract

AIM: To analyze the factors that influence the prediction error (PE) after intraocular lens (IOL) implantation in pediatric cataract. METHODS: The medical records of cataract patients of no more than 14 years old who had primary IOL implantation were reviewed from 2006 to 2010. The PE, absolute value of PE (APE), and predictability between in different axial length, mean corneal curvature, corneal astigmatism, and age at the surgery were analyzed. RESULTS: Seventy-five children (119 eyes) were included, with a mean age of (5.09±2.54) years. At the follow-up of (1.19±0.69) months, the mean postoperative PE was (-0.22±1.12) D, and APE was (0.87±0.73)D. The PE in eyes with an axial length ＞20mm but ≤22mm were significantly under-corrected than that in eyes with longer axis, and the APE in eyes with an axial length ≤20mm was more obvious compared with the others. The correlations between PE and axial length, as well as corneal astigmatism, and between APE and axial length were significant. The predictability was significantly poorer in the eyes with an axial length ≤20mm than the others. CONCLUSION: The axial length is closely related with the PE after IOL implantation in pediatric cataract patients, especially when it is ≤20mm, PE is more significant. The formula that is more suitable to very short axial length should be explored.     

儿童白内障手术后二期人工晶状体植入的探讨

目的 探讨儿童白内障术后二期人工晶状体植入术的效果。方法 回顾了34例(41眼)儿童白内障手术后二期人工晶状体植入5年记录。介绍了二期人工晶状体植入的适应证，人工晶状体植入的手术方法。术前、术后视力、屈光不正。双眼状态和手术方法。结果 34例(41眼)儿童白内障手术后二期人工晶状体植入。其中8眼成功囊袋内植入，28眼睫状沟植入，余5眼行后房人工晶状体悬吊术。41眼中35眼(85．37％)有可测量的视力提高，有3眼视力降低2行。24眼(58．54％)与对侧眼的矫正屈光度差在 1．50D以内。31眼(75．61％)屈光度差在 3．00D以内。结论 对于不能耐受接触镜或眼镜的儿童无晶状体眼，二期后房型人工晶状体植入是一种安全、有效的选择。     

Microincisional cataract surgery and Thinoptx rollable intraocular lens implantation

Background Microincisional cataract surgery is a safe procedure with a very short learning period for an experienced cataract surgeon and rollable ultrathin intraocular lenses eliminate the need for enlargement of corneal incision. The purpose of the study was to evaluate the safety and efficacy of cataract surgery through a corneal microincision and implantation of rollable ultrathin intraocular lenses. The setting was Dokuz Eylul University Medical Faculty, Ophthalmology Department, Izmir, Turkey and SSK Okmeydani Hospital, Ophthalmology Clinic, Istanbul, Turkey.Patients and methods Ninety eyes in 85 patients were operated on through clear corneal microincisions with sleeveless phacoemulsification and rollable intraocular lenses were implanted. Forty-six of the patients were men and 39 were women between the ages of 27 and 83, with a mean of 51 years. Two eyes had atrophic senile macular degeneration, 4 eyes had nonspecific retinal pigment epithelial changes with chorioretinal atrophy, and 4 patients had diabetes mellitus without retinopathy. Three eyes had posterior capsular opacifications of unknown etiology. Two eyes had primary open angle glaucoma (PAAG) with cup to disc ratios of about 0.5. Three eyes had dense nuclear sclerosis of grade 4 with very low visibility of retinal structures. Other patients had no ocular or systemic pathology other than nuclear/corticonuclear cataract of grade 2–3. Uncorrected and best spectacle-corrected distance and near visual acuities, keratometric values, and refractive status were noted preoperatively and 1 week, 1 month, and 6 months postoperatively. Statistical analysis of keratometric changes between preoperative and postoperative findings was performed using the paired samples t test.Results At 6 months postoperatively, 1 patient had a best spectacle-corrected visual acuity (BSCVA) of 0.2, the patient with atrophic senile macular degeneration. The rest of the eyes achieved a BSCVA of 0.63 or better. At 6 months postoperatively, 55 (61.11%) eyes had uncorrected visual acuities (UCVA) equal to or better than 0.8 and 83 (92.22%) eyes had BSCVA equal to or better than 0.8 according to the Snellen chart. The mean postoperative corneal astigmatisms at 1 week, 1 month, and 6 months were 0.69±0.43 D, 0.66±0.46 D and 0.65±0.48 D respectively. Statistical analysis revealed a significant change in corneal astigmatisms at the 1st week visit (p<0.05), but not at the 1st and 6th month visits (p>0.05) compared with preoperative findings.Conclusion Based on the limited data in the literature and in this study, it is not possible to make concrete decisions about the benefits and disadvantages of the ThinOptx IOL for longer durations. Intraoperatively, this IOL apparently eliminates the need for enlargement of the corneal incision during implantation. However, the statistical insignificance of induced astigmatisms after microincisions and classical phacoincisions should also be taken into consideration. We conclude that ThinOptx IOL is a pioneering intraocular lens implant that will contribute to the exciting future of cataract refractive surgical procedures. However, both clinical and laboratory investigations are needed to clearly describe the long-term effectiveness of this new rollable IOL.Authors do not have any proprietary interest in any of the materials mentioned in the textThis study did not receive any public or private fundingThis study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki     

儿童白内障人工晶状体植入临床观察

目的　观察儿童白内障人工晶状体植入术后远期视力、双眼视、屈光状态和手术并发症情况。方法　 12岁以下儿童白内障共 35例 5 4眼进入本次研究。其中单眼外伤性白内障 6例 ,单眼先天性白内障 10例 ,双眼先天性白内障 19例。定期检查患儿的最佳矫正视力 (Bestcorrectedvisualacuity ,BCVA)、双眼视功能、远期屈光状态和手术并发症。平均随访时间为 37 8± 18 6个月。结果　 2 7只眼 (5 0 0 % )BCVA≥ 0 5。 13例患儿 (37 1% )Titmus立体视≤ 10 0弧秒。术眼的远期平均屈光度为 - 0 76± 3 2 5D。 4 9只眼 (90 7% )在不同时期发现后发障 ,6只眼 (11 1% )有部分虹膜后粘和瞳孔移位 ,9只眼 (16 7% )出现 <15°的外斜视。 5例双眼先天性白内障存在双眼水平震颤。结论　儿童白内障及时诊断 ,早期手术 ,采用白内障摘除联合IOL植入可以获得较好的视功能。后发障是主要的术后并发症。长期随访很重要。术后后发障等并发症和弱视治疗是获得良好视功能的关键。     

玻璃体切除联合白内障摘出人工晶状体植入术

目的探讨玻璃体切除联合白内障摘出及人工晶状体植入术的临床效果。方法对16例(17眼)玻璃体视网膜疾病伴有明显的白内障者实施了此联合手术。先行常规白内障囊外摘出术或晶状体超声乳化术,再行标准三通道闭合式玻璃体切除术,最后植入人工晶状体。结果术后随访2月～3年,平均13月。16眼术后视力均有不同程度提高,1眼增生性糖尿病性视网膜病变术后2月因继发新生血管性青光眼,行广泛视网膜冷凝后视力下降。术后早期16例(17眼)均有不同程度的角膜后弹力层皱褶,术后7～10d消失。2例(2眼)术后有一过性眼压升高。1例(1眼)术后2月发生新生血管性青光眼。3例(3眼)术后后囊浑浊,未影响视力。结论此联合手术的临床效果良好,具有一定的优点,但应严格掌握适应证,并要求有熟练的手术技巧。     

青光眼术后白内障的超声乳化人工晶状体植入

目的 探讨超声乳化联合折叠型人工晶状体植入术治疗青光眼术后白内障的临床疗效.方法 88例(90眼)青光眼术后白内障随机分为治疗组43例(45眼)和对照组45例(45眼),治疗组采用透明角膜切口晶状体超声乳化联合折叠型人工晶状体植入术,对照组常规采用白内障囊外摘出术.随访术后1周、1个月、3个月裸眼视力及角膜散光度.结果 治疗组术后1周、1个月和3个月裸眼视力＞0.5者明显高于对照组(P＜0.01).两组在术后3个月平均角膜散光度的差异有统计学意义(P＜0.01).结论 抗青光眼术后透明角膜切口晶状体超声乳化联合折叠型人工晶状体植入术具有较好的临床疗效,有利于减少术后角膜散光,获得更好的裸眼视力.     

外伤性白内障后房型人工晶状体一期植入分析

目的 探讨外伤性白内障后房型人工晶状体一期植入术的临床效果. 方法对118例(118只眼)外伤性白内障患者行白内障摘除联合后房型人工晶状体一期植入术,随访3~12个月,并对术后疗效及并发症进行分析.结果 术后矫正视力≥0.05者109例占92.4%;≥0.3者81例占68.6%;≥0.5者52例占44.1%;≥0.8者23例占19.5%.术后常见并发症为早期角膜水肿、葡萄膜炎、人工晶状体夹持、继发性青光眼.但经过相应的处理,并发症都能得到很好的控制.结论 外伤性白内障摘除的同时行后房型人工晶状体一期植入是安全有效的.     

Optical quality of toric intraocular lens implantation in cataract surgery

AIM: To analyze the optical quality after implantation of toric intraocular lens with optical quality analysis system. METHODS: Fifty-two eyes of forty-four patients with regular corneal astigmatism of at least 1.00 D underwent implantation of AcrySof toric intraocular lens, including T3 group 19 eyes, T4 group 18 eyes, T5 group 10 eyes, T6 group 5 eyes. Main outcomes evaluated at 3mo of follow-up, included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual refractive cylinder and intraocular lens (IOL) axis rotation. Objective optical quality were measured using optical quality analysis system (OQAS Ⅱ?, Visiometrics, Spain), included the cutoff frequency of modulation transfer function (MTFcutoff), objective scattering index (OSI), Strehl ratio, optical quality analysis system value (OV) 100%, OV 20% and OV 9% [the optical quality analysis system (OQAS) values at contrasts of 100%, 20%, and 9%]. RESULTS: At 3mo postoperative, the mean UDVA and CDVA was 0.18±0.11 and 0.07±0.08 logMAR; the mean residual refractive cylinder was 0.50±0.29 D; the mean toric IOL axis rotation was 3.62±1.76 degrees, the mean MTFcutoff, OSI, Strehl ratio, OV 100%, OV 20% and OV 9% were 22.862±5.584, 1.80±0.84, 0.155±0.038, 0.76±0.18, 0.77±0.19 and 0.78±0.21. The values of UDVA, CDVA, IOL axis rotation, MTFcutoff, OSI, Strehl ratio, OV100%, OV20% and OV9% depending on the power of the cylinder of the implantation were not significantly different (P>0.05), except the residual refractive cylinder (P<0.05). CONCLUSION: The optical quality analysis system was useful for characterizing the optical quality of AcrySof toric IOL implantation. Implantation of an AcrySof toric IOL is an effective and safe method to correct corneal astigmatism during cataract surgery.     

Optimization of intraocular lens selection for pediatric cataract surgery

Graefe's Archive for Clinical and Experimental Ophthalmology -     

儿童白内障手术人工晶状体度数计算准确性分析

目的 分析儿童眼人工晶状体度数计算的准确性.方法 回顾性研究37例(62只眼)行先天性白内障摘除加人工晶状体(IOL,intraocular lens)植入术患儿生物测量及屈光状态数据,应用SRKⅡ计算IOL度数.术后2个月行视网膜检影验光检测屈光状态.分析手术年龄,眼轴长度,IOL植入时机与IOL度数计算准确性关系.结果 全部平均绝对预测误差为(1.56±1.43)D.绝对预测误差低于1.0 D共32只眼,占总眼数52%.眼轴≤20 mm组绝对预测误差为(2.75±1.66)D,＞20 mm组为(1.06±0.93)D,2组间差异具有统计学意义(P＜0.01).年龄≤2岁组绝对预测误差为(2.38±1.65)D,＞2岁为(1.04±0.99)D,2组间差别具有统计学意义(P＜0.01).Ⅰ期IOL植入组绝对预测误差为(1.37±1.35)D,Ⅱ期IOL植入为(2.03±1.56)D,2组间差异无统计学意义(P=0.22).结论 全组植入的IOL度数安全有效.眼轴≤20 mm及年龄≤2岁患儿绝对预测误差明显增加.该研究证明,专门为儿童眼设计IOL计算公式是有必要的.

Abstract：

Objective To determine the accuracy of intraocular lens (IOL) power calculation in a group of pseudophakic children. Methods A relrospective analysis of biometric and refractive data was performed on 62 eyes of 37 infants and children, who successfully underwent cataract extraction and IOL implantation. SRKII were used to calculate the IOL power. The postoperative refractive outcome was taken as the spherical equivalent of the refraction at 2 months afier surgery by retinoscopy. The data were analyzed to assess the effects of age at the time of surgery, axial length, and primary or secondary intraocular lens implantation on the accuracy of calculation of IOL power. Results For the overall group the mean and median prediction errors were 1.56D (SD 1.43). There were 32 eyes'absolute predictions errors lower than 1D (52%). The mean absolute prediction errors in eyes with axial lengths≤20 mm were 2.75 D (SD 1.66), and in eyes ＞20 mm were 1.06 D (SD 0.93). The mean absolute prediction errors in eyes in children aged≤2 years were 2.38 D (SD 1.65), and in children aged ＞2 years were 1.04D (SD 0.99). The differences between the absolute prediction errors for both axial length and age were statistically significant (P ＜0.01). The mean-absolute prediction errors in eyes with primary IOL implantation were 1.37D (SD 1.35), and secondary intraocular lens implantation were 2.03D (SD 1.56). The differences between the absolute prediction errors primary or secondary intraocular lens implantation, were not statistically significant (P =.22). Conclusions For the overall group IOL power calculation is generally acceptable. In eyes with axial lengths less than 20 mm and in children younger than 2 years of age larger errors can arise, and the variations increase. This study demonstrates the need for an IOL formula specifically designed for pediatric use.