Risk factors for complications after congenital cataract surgery without intraocular lens implantation in the first 18 months of life

PURPOSE: To determine individual risk factors for the development of postoperative complications after pediatric cataract surgery in the first 18 months of life. DESIGN: Interventional, consecutive case series. METHODS: We retrospectively reviewed the records of 71 eyes of 46 children who underwent surgery for congenital cataract within the first 18 months of life. A limbal approach bimanual lens aspiration, posterior capsulorrhexis, and anterior vitrectomy without intraocular lens implantation was performed in all children. We examined the interrelationships of operative and postoperative complications with other variables such as patient age, family history, or ocular abnormalities. The mean follow-up period was 39 months. RESULTS: The most frequent postoperative complications were late-onset open-angle glaucoma (10.8%) and vitreous hemorrhage (10.8%), whereas early-onset glaucoma (4.6%) was less common. Secondary cataract was observed in seven eyes (9.2%). We determined a family history of aphakic glaucoma in first-degree relatives (P = .007) as well as cataract surgery in the first three months of life (P = .039) and nuclear cataracts (P = .0009) to be strong predictors of late-onset glaucoma. Secondary cataract formation was associated strongly with lensectomy in the first five months of life. The diagnosis of postoperative hemorrhages was associated significantly with the presence of persistent fetal vasculature (P < .0001). CONCLUSIONS: Patients with preoperative predictors at presentation such as young age at the time of surgery, a family history of aphakic glaucoma, nuclear cataract, or persistent fetal vasculature syndrome offer a clear target for extensive postoperative care after congenital cataract surgery.     

A comparison of grating visual acuity, strabismus, and reoperation outcomes among children with aphakia and pseudophakia after unilateral cataract surgery during the first six months of life.

PURPOSE: The method of correcting aphakia after unilateral cataract extraction during infancy is controversial. Some authorities advocate correction with an intraocular lens (IOL) whereas others advocate correction with a contact lens (CL). We compared grating visual acuity, alignment, and reoperative outcomes in age-matched children treated with these 2 modalities at 5 clinical centers. METHODS: Twenty-five infants born in 1997 or 1998 with a dense unilateral congenital cataract who had cataract surgery coupled with (IOL group, n = 12) or without (CL group, n = 13) primary IOL implantation were enrolled in this study. All patients were prescribed half-time occlusion therapy. In July 1999, their grating visual acuities, ocular alignments, and reoperation rates were assessed. RESULTS: The mean grating visual acuity (LogMAR) for the affected eye was 0.70 +/- 0.32 for the IOL group and 0.87 +/- 0.31 for the CL group (P =.19). The mean interocular difference in grating visual acuity was 0.26 +/- 0.30 for the IOL group and 0.50 +/- 0.28 for the CL group (P =.048). The incidence of strabismus (>10 PD) was 75% in the IOL group compared with 92% in the CL group (P =.24). The incidence of reoperations was 83% in the IOL group compared with 23% in the CL group (P =.003). CONCLUSIONS: Our preliminary data suggest that correcting aphakia after unilateral congenital cataract surgery with primary IOL implantation results in an improved visual outcome but a higher rate of complications requiring reoperation. A randomized clinical trial, the Infant Aphakia Treatment Study, is planned to further study the optimal treatment for aphakia following unilateral cataract extraction during infancy.     

高度近视并发性白内障人工晶体植入后视力康复的相关因素分析

目的：探讨高度近视白内障人工晶体植入术后视力康复的相关因素。方法：统计分析42例（66眼）高度近视白内障患者行ECCE＋IOL术（38眼）和PHACO＋IOL术（28眼）后视力康复与性别、年龄、眼轴、手术方式的关系。结果：术后最佳视力（含矫正）：≥0．3者50眼（78．5％）,≥0．5者22例。其中视力大于等于0．5的患者眼轴多＜30mm（21眼）。结论：高度近视并发性白内障人工晶体植入术后视力康复程度与患者眼底变性程度、眼轴、术中操作技巧正相关,与年龄、性别、术式选择关系不大;高度近视白内障手术能明显提高患者视力,但因其并发症相对多,应在推广及实施此类手术时引起重视。     

Strabismus and diplopia as complications after cataract surgery with IOL implantation

Summary In our Department of Orthoptics we have seen an increasing number of patients suffering from diplopia after cataract surgery with IOL implantation. Between 1993 and 1997 the total number of patients with this problem was 24 (2.7 % of all patients, mean age 71 years, age range 38–88). We addressed the question of whether there is a common pattern of motility dysfunction. Methods: After evaluation of the clinical history and the basic ophthalmological findings the following parameters were examined: binocular function (Bagolini test), squint angles (Maddox cross), ocular motility. Results: The 24 patients could be divided up into three groups. Group 1 consisted of 9 patients (mean age 82 years, range 64–88) who complained about diplopia because of strabismus incomitans with vertical deviation and restricted motility on the first day after surgery. In 8 of the 9 patients strabismus surgery was done. Group II consisted of 10 patients (mean age 66 years, range 38–77) who noticed diplopia and strabismus within 7 days after surgery. We found various kinds of heterotropia. Seven of these patients were operated on and two had a prism correction. Group III consisted of 5 patients (mean age 67 years, range 61–78). Their already known strabismus paralyticus or concomitans deteriorated, leading to diplopia in some cases. All patients in this group were operated on. Discussion: For group I we believe that retro-, para- or peribulbar anesthesia caused the motility dysfunction. In groups II and III it is unlikely that local anesthesia had a causative role. The prolonged disruption of binocular vision and the abrupt change in the sensory situation after the cataract operation with lens implantation may be the leading causes for strabismus or deterioration of a preexisting strabism, respectively. Conclusions: These patients need a subtil meticulous diagnostic work-up and follow-up because of the possibility of early surgical therapy, which has a good prognosis. Evaluation of binocular vision and eye movements prior to cataract surgery appears to be helpful for later strabismic surgery.      

Practically corrected visual acuity after extracapsular cataract extraction with or without intraocular lens implantation.

We examined retrospectively a total of 171 patients (236 eyes) who had undergone extracapsular cataract extraction (ECCE) with or without intraocular lens implantation (IOL). The best and practically corrected visual acuities were determined 6 months after surgery. Practically corrected visual acuity of the ECCE group was significantly worse than that of ECCE plus IOL group of patients who had undergone unilateral cataract surgery. In patients who had undergone bilateral surgery, visual improvement was almost optimal in both groups. With regard to practically corrected visual acuity, ECCE plus IOL was the preferable procedure for elderly patients who had had unilateral cataract.     

白内障手术Ⅰ期人工晶状体未植入原因分析

目的：探讨白内障手术Ⅰ期人工晶状体未植入的原因,方法：回顾性分析540眼白内障手术23眼未能Ⅰ期植入人工晶状体的手术资料。结果：白内障手术影响Ⅰ期人工晶状体植入的主要原因为晶状悬韧带断离,晶状体后囊膜破裂、玻璃体脱出。结论：提高白内障手术操作技巧,减少并发症发生,是确保Ⅰ期人工晶状体植入的关键。     

小切口非超声乳化白内障手术联合人工晶状体植入术后屈光状态的分析

目的分析小切口非超声乳化白内障手术联合人工晶状体植入术术后屈光状态。方法老年性白内障52例（68眼）。术前应用手动角膜曲率计及眼科A/B超测量角膜曲率及眼轴长度,计算所需人工晶状体度数,全部行小切口白内障囊外摘出联合PMMA人工晶状体植入术,术后观察视力、角膜曲率、散光及实际屈光度。结果所有手术均顺利完成,术后3月,裸眼视力0.5～0.8者51眼（75.00%）,裸眼视力〉0.8者13眼（19.12%）;最佳矫正视力〈0.5者4眼（5.88%）（检查发现此4眼为老年性黄斑变性）。角膜曲率平均K值44.22±1.45,角膜散光（0.98±0.76）D,与术前比较,差别均无统计学意义（P〉0.05）;术后屈光度等值球镜（0.10±0.95）D,与术前预测目标屈光度差别有高度统计学意义（P〈0.02）。结论现代小切口非超声乳化白内障摘出术对角膜散光影响较小,手术安全,并发症少。但术后实际屈光度与术前预测值存在差别,应在工作中进一步探索准确计算所需人工晶状体度数的手段。     

青光眼术后并发白内障的人工晶状体植入术

目的 探讨抗青光眼术后白内障患者的手术方法和效果。方法 对自1993年至2000年50例58眼抗青光眼滤过术后白内障囊外摘出及人工晶状体植入方法进行了回顾。上方角膜缘内1mm处作6～7mm弧长切口,水分离娩核,后房人工晶状体植入。结果 58眼术后视力均有提高。术中、术后无严重并发症。结论 经过角膜切口治疗青光眼术后的白内障取得良好效果,无严重并发症,未损伤滤过泡。     

白内障植入Toric IOL和单焦点非Toric IOL术后疗效观察

目的观察白内障手术中使用ToricIOL对视力和屈光结果的临床疗效.方法2012年7月至2015年7月在无锡市第九人民医院眼科手术治疗的白内障患者77例(108只眼).患者共分为3组.A组:角膜散光度≥2.0 D植入Toric单焦点晶状体22例患者(30只眼);B组:角膜散光度≥2.0 D植入单焦点非Toric晶状体25例患者38只眼;C组:角膜散光度≤1.5 D植入单焦点非Toric晶状体30例(40只眼).术后随访1周至2个月,观察其裸眼视力、最佳矫正视力、屈光度、角膜散光值,综合各指标评估Toric晶状体的有效及安全性.结果术后三组的裸眼视力LogMAR:A组0.25±0.21;B组0.52±0.22;C组0.16±0.25.最佳矫正视力LogMAR分别是:A组0.08±0.12;B组0.22±0.14;C组0.04±0.11.术前的角膜散光分别是A组(3.68±1.21)D;B组(3.42±1.47)D;C组(0.95±0.41)D.术后眼球散光度分别是A组(1.1±0.65)D;B组(3.15±1.35)D;C组(0.91±0.52)D.术后散光度A组和B组比较有显著的统计学意义(P≤0.001),而在A组和C组之间无明显的统计学意义(P=0.17).结论在白内障手术的同时,相对于角膜散光较大的患者,Toric晶状体植入可以矫正角膜散光,提高视力,是一种安全,有效的选择.     

小切口非乳化人工晶状体植入术房角及眼压观察

目的 探讨非超声乳化隧道切口白内障手术内切口对周边虹膜的影响及眼压的变化。方法 26例27眼老年性白内障进行术后定期随访前房角及眼压。结果 27眼内切口位于Schwalbe线前的透明角膜上。2眼(7．4％)虹膜周边前粘连，12眼角膜后弹力层脱离(44．4％)，14眼(51．8％)因黏弹剂残留引起高眼压。结论 通过非超声乳化隧道切口进行白内障人工晶状体植入术观察，周边虹膜前粘连发生率低，应术后严格注意观察眼压，以便及时处理。     

Unilateral intraocular lens implantation during the first six months of life

PURPOSE: The purpose of this study was to determine the incidence of postoperative complications and the occurrence of myopic shift in infantile eyes after cataract surgery and implantation of an intraocular lens (IOL). METHODS: Cataract surgery and IOL implantation was performed on 11 infants with unilateral congenital cataracts who had a mean age of 10+/-6 weeks at 5 clinical centers. IOLs with a mean power of 26.2+/-2.3 D were implanted using a standardized protocol. The infants were then followed up for a mean of 13+/-6 months for postoperative complications and longitudinal changes in their refractive error. RESULTS: Eight of the 11 eyes had postoperative complications and were treated with a reoperation. Complications included open-angle glaucoma (n = 2), lens reproliferation into the visual axis (n = 2), pupillary membranes (n = 2), and corectopia (n = 2). A younger age at the time of surgery was positively correlated with the development of a postoperative complication requiring a reoperation (P = .03). A mean myopic shift of 5.49 D occurred in these eyes a year after surgery. No preoperative factors could be identified that correlated with the magnitude of the myopic shift. CONCLUSION: IOL implantation during infancy is associated with a high complication rate frequently requiring reoperation. A large myopic shift typically occurs that necessitates an initial or a late overcorrection with spectacles or a contact lens, depending on the power of the IOL implanted. Until ongoing randomized trials are completed, we recommend that surgeons exercise caution before implanting IOLs in the eyes of infants.     

Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis

Purpose: Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation. Methods: Retrospective analysis after phacoemulsification with in‐the‐bag IOL implantation was performed in 16 patients (17 operations) with ANA‐positive JIA‐associated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection. Results: Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression/biologicals. After surgery (mean follow‐up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension/glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved (≥2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them. Conclusions: Phacoemulsification and in‐the‐bag IOL implantation may improve visual outcome in JIA‐associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well‐controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement.     

Complications in the first year following cataract surgery with and without IOL in infants and older children.

PURPOSE: The optimal role of intraocular lenses (IOLs) in infants remains a controversial topic for many reasons, including concerns about significant complications occurring in young rapidly developing eyes. METHODS: To assess the number and type of significant complications requiring further intervention occurring in the first postoperative year, we reviewed the records of 15 eyes of 13 infants undergoing lensectomy with posterior chamber IOL and pars plana vitrectomy (PPV)/capsulectomy under 6 months (group A) of age as part of an ongoing prospective study of IOL use in infants. This group was compared with a group of 16 children age 10 months to 5 years undergoing an identical procedure (group B) and a group of 33 infants less than 6 months of age undergoing lensectomy/vitrectomy without IOL (group C). RESULTS: Thirteen of 15 eyes in group A required additional surgery in the first postoperative year. Twelve of the 15 eyes (80%) developed secondary opacification across the visual axis posterior to the IOL requiring a second PPV and one eye developed pseudophakic glaucoma. Two patients required a third PPV to keep the visual axis clear. In group B, 0 of 16 (P <.0001) developed secondary opacification of the visual axis. In group C, 4 of 33 (12%; P <.0001) developed pupillary opacification in the first postoperative year. CONCLUSIONS: Intraocular lens implants in infants may be associated with a higher complication rate requiring further surgery during the first postoperative year than is lensectomy/vitrectomy surgery without IOL implant in infants or lensectomy/IOL/vitrectomy surgery in children older than 6 months of age.     

区域折射型多焦点与非球面单焦点IOL植入术后视力及视觉质量分析

目的：对比区域折射型多焦点人工晶状体(IOL)和非球面单焦点IOL植入术后患者的全程视力及视觉质量。

方法：前瞻性选取2017-01/2019-08于我院眼科接受白内障超声乳化吸除联合IOL植入术的年龄相关性白内障患者82例96眼,根据术中植入的IOL类型分为观察组(46例53眼,植入Oculentis MF30区域折射型多焦点IOL)和对照组(36例43眼,植入ADAPT AO非球面单焦点IOL)。比较两组患者术后3mo的全程视力和视觉质量。

结果：术后3mo,与对照组相比,观察组近、中视力显著改善,对比敏感度显著提高,调制传递函数截止频率、斯特列尔比、客观调节幅度以及模拟视力显著增加,VF-12-CN评分显著降低(38.16±4.05分 vs 45.72±4.69分),脱镜率评分(11.38±1.04分 vs 9.23±0.87分)和手术满意度评分(3.57±0.36分 vs 3.32±0.31分)显著升高(P<0.05)。年龄>65岁、文盲、好眼裸眼远视力≥0.1(LogMAR)、植入非球面单焦点IOL是导致白内障患者生活质量下降的影响因素。

结论：与非球面单焦点IOL相比,区域折射型多焦点IOL术后短期可提供良好的全程视力,对比敏感度、视觉质量、生活质量、脱镜率以及满意度均显著提高。     

小切口非超声乳化摘出外滤过术后白内障的临床研究

目的 评价小切口非超声乳化摘出外滤过术后白内障的手术效果。方法 对５８例外滤过术后白内障（５级核）行非超也化摘出。结果 ５８例术后视力均得到提高,术前,术后的眼压无显著性差异,无并发症发生。结论 对外滤过术后的白内障,尤其是高龄患者且为５级核者,行小切口非超声乳化治疗,只要方法得当,同样可以取得良好效果。