.
Purpose: To determine the incidence and risk factors for glaucoma in pseudophakic and aphakic eyes following surgery for congenital cataract within the first year of life.
Methods: We conducted a review of all cataract surgery performed at our unit over a 23‐year period. Age at surgery, corneal diameter, intraocular lens implantation, presence of persistent foetal vasculature and visual axis opacification (VAO) were documented. Time to development of glaucoma, management and outcome were determined. One eye was selected randomly for analysis in cases of bilateral cataract.
Results: Duration of follow‐up was significantly longer (p < 0.001) in the aphakic (113 ± 69 months) compared to the pseudophakic group (56 ± 44 months). Age at surgery was significantly less (p = 0.01) in the aphakic group. The incidence of glaucoma was significantly greater (p = 0.02) in the aphakic (15 eyes, 33%) compared to the pseudophakic (seven eyes, 13%) group. Each eye that developed glaucoma underwent cataract extraction aged ≤ 2.5 months. Analysis of all eyes that underwent surgery aged ≤ 2.5 months revealed no statistical difference (p = 0.08) in the incidence of glaucoma. Smaller corneal diameter and VAO were not associated with increased risk of glaucoma development. Ahmed valves proved effective in controlling intraocular pressure but visual outcome was poor in the majority of cases.
Conclusion: Surgery for congenital cataract at an early age increases the risk of glaucoma development, regardless of whether the eye is aphakic or pseudophakic. Intraocular pressure control with Ahmed valves is frequently required. Glaucomatous damage and dense amblyopia contribute to poor visual outcome in these eyes.
Visual axis reopacification was the main complication of IOL implantation in infants, with PHPV leading to more complications and repeat procedures. Anterior vitrectomy appeared to reduce the reoperation rate. Results indicate that primary posterior capsulorhexis is important and Nd:YAG capsulotomy is not satisfactory in infants. In addition, the reduction in glaucoma with IOL implantation, if borne out over the long term, is a significant advantage in cases of congenital cataract.
Aim-To assess changes in axial length, corneal curvature, and refraction in paediatric pseudophakia. Methods-35 eyes of 24 patients with congenital or developmental lens opacities underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation. Serial measurements were made of axial length, corneal curvature, objective refraction, and visual acuity. Results-For patients with congenital cataracts (onset <1 year age) the mean age at surgery was 24 weeks. Over the mean follow up period of 2.7 years, the mean increase in axial length of 3.41 mm was not significantly diVerent from the value of an expected mean growth of 3.44 mm (paired t test, p=0.97) after correction for gestational age. In the developmental cataract group (onset >1 year of age) the mean age at surgery was 6. Conclusion-The pattern of axial elongation and corneal flattening was similar in the congenital and developmental groups to that observed in normal eyes. No significant retardation or acceleration of axial growth was found in the eyes implanted with IOLs compared with normal eyes. A myopic shift was seen particularly in eyes operated on at 4-8 weeks of age and it is recommended that these eyes are made 6 D hypermetropic initially with the residual refractive error being corrected with spectacles. (Br J Ophthalmol 1999;83:265-269) Among the problems which arise regarding the use of intraocular lenses (IOLs) in the paediatric population is the question of the power of the implant that should be used, considering the expected growth of the child's eye. The majority of eye growth takes place in the first 18 months of life after which there is little change.
Eight children with the fetal alcohol syndrome are described with ocular anomalies. They all had a strong history of maternal alcohol abuse throughout pregnancy, especially in the first trimester. All the children had eye abnormalities. These included external eye lesions, Peters' anomaly, lens opacification, ocular motility disorders, and optic nerve hypoplasia.Fetal alcohol syndrome is characterised by at least three of the following findings: (1) A 6-month-old boy was born at 41 weeks gestation with meconium grade 3. He had a marked bradycephaly, developmental delay, a right congenital dislocation of hip, and an inguinal
Laser treated eyes with favourable structural outcome have a good visual outcome. The results show a long term benefit from diode laser photocoagulation in preserving distance and near vision in eyes with threshold ROP.
PURPOSETo assess the long-term refractive and biometric outcomes of diode laser-treated eyes in threshold retinopathy of prematurity (ROP).
METHODSCycloplegic autorefraction and biometry (Zeiss IOLMaster) were performed, at a mean follow-up of 11 years, on 16 laser-treated eyes with threshold ROP and 9 comparison eyes with subthreshold untreated ROP.
RESULTSThe laser-treated eyes had a mean spherical equivalent of Ϫ2.33 D with a mean astigmatic error of 1.38 D. The comparison eyes had a mean spherical equivalent of ϩ1.07 D with a mean astigmatic error of 0.42 D. This trend toward increased myopia in treated eyes did not achieve statistical significance ( p ϭ 0.08). The myopia in the laser group appeared to be slowly progressive in nature when compared with earlier refractive data for these patients. The laser-treated eyes had reduced anterior chamber depth (ACD) compared with the subthreshold eyes ( p ϭ 0.02). When physiologic accommodation was inhibited by cycloplegic drops, the anterior chamber deepened by 0.13 mm in the laser-treated eyes and by 0.06 mm in the comparison eyes. This effect of accommodation on ACD did not differ significantly between the two groups ( p ϭ 0.23). The laser-treated eyes and the comparison eyes did not differ significantly in terms of axial length, corneal power, corneal diameter, or lens power. However, both groups had steeper corneas, shallower anterior chambers, and shorter axial lengths when compared with historical full-term controls.
CONCLUSIONSMyopia in premature infants requiring laser treatment for ROP is associated with a shallowing of the anterior chamber and a steepening of the cornea. Physiological accommodation is not impaired by laser therapy or by severe ROP. ( J AAPOS 2006;10: 454-459) P rematurity and retinopathy of prematurity (ROP) are well-established independent risk factors for myopia. [1][2][3][4] There have been reports that cryotherapy in threshold ROP contributes to the development of myopia and that laser photocoagulation, in comparison, produces less myopic shift. 5-7 However, Quinn et al felt that the cryotherapy did not result in additional myopia but that the high myopia was related to the cicatricial retinopathy or severity of ROP. 8 In recent times, laser photocoagulation has largely replaced cryotherapy as the established treatment modality for ROP. Davitt et al have shown no increase in myopia or high myopia, at 9 months, in laser-treated compared with untreated high-risk prethreshold ROP eyes in the Early Treatment of Retinopathy of Prematurity (ETROP) study. 9 The clinical objective of this study was to evaluate the long-term refractive outcome of threshold ROP eyes at a mean of 11 years after diode laser treatment, with particular attention to the role of the cornea, anterior chamber depth, axial length, and effective lens power in determining the refractive status.A comparison group with documented subthreshold ROP, which had regressed spontaneously without laser treatment, was also evaluated.
Materials and MethodsAll premature babies who...
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