Long term outcomes of bilateral congenital and developmental cataracts operated in Maharashtra, India. Miraj pediatric cataract study III

Abstract

Aim:To study long term outcome of bilateral congenital and developmental cataract surgery.Subjects:258 pediatric cataract operated eyes of 129 children.Materials and Methods:Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF) were noted for before and after surgery.Statistics:Statistical analysis was done with SPSS version 16 including multi-variate analysis.Results:Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years) at the time of surgery. 74/129 (57.4%) were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years). 177 (68.6%) eyes had vision <3/60 before surgery, while 109 (42.2%) had best corrected visual acuity (BCVA) >6/18 and 157 (60.9%) had BCVA >6/60 3-8 years after surgery. 48 (37.2%) had binocular stereoacuity <480 sec of arc by TNO test. Visual outcome depended on type of cataract (P = 0.004), type of cataract surgery (P < 0.001), type of intra-ocular lens (P = 0.05), age at surgery (P = 0.004), absence of post-operative uveitis (P = 0.01) and pre-operative vision (P < 0.001), but did not depend on delay (0.612) between diagnosis and surgery. There was a statistically significant improvement for all the 20 questions of the LVP-CVF scale (P < 0.001).Conclusion:Pediatric cataract surgery improved the children's visual acuity, stereo acuity and vision function. Developmental cataract, use of phacoemulsification, older children and those with better pre-operative vision had betterlong-termoutcomes.

Unilateral Congenital and Developmental Cataracts in Children in India

“…The bilateral congenital and developmental cataracts had BCVA of 6/18 or greater in 109 eyes (42.2%) compared with 25% in this unilateral series, whereas the bilateral ones had BCVA of 6/24 to 6/60 in 48 (18.6%) and less than 6/60 in 101 (39.1%) eyes after surgery compared with 66.7% less than 6/60 in this unilateral series. 10 The outcome of 25% of eyes with visual acuity of 6/18 or greater was comparable to results from China (25.3% of eyes The Chinese study reported that there was no difference in unilateral cataracts operated on before age 3 and those operated on after 3 years. It concluded that surgical removal and effective visual rehabilitation did not guarantee good vision in unilateral congenital and developmental cataracts.…”

“…There may be a delay between diagnosis and surgery in bilateral developmental and congenital cataracts, but the resulting visual deprivation amblyopia was similar in both eyes, unlike in unilateral cases where cortical competition rendered 1 eye severely amblyopic. 10 Eyes with some vision before surgery also had better visual outcomes perhaps because their visual systems had an opportunity to develop, unlike those eyes with dense cataracts. The results were poorer compared with bilateral congenital and developmental cataracts operated on in the same setting with a 3-to 7-year follow-up.…”

“…More diligent cortical cleanup and capsule polishing may be a factor for better outcomes. 10 The instances of postoperative uveitis and increased intraocular pressure were too few to comment on their significance. Delay between diagnosis and surgery was also not significantly responsible because almost all cataracts were operated on late.…”

Global challenges in the management of congenital cataract: proceedings of the 4th International Congenital Cataract Symposium held on March 7, 2014, New York, New York

“…9 There are excellent surgical training programs in the region, but most pediatric ophthalmologists do not live or work in rural areas. Pediatric cataract surgery is generally performed by either a pediatric or general ophthalmologist 41 in 1 of 30-40 tertiary care centers. It has been noted that surgery for girls with congenital cataracts is more often performed in secondary care centers lacking the expertise of tertiary care centers.…”

“…42 In the setting of a clinical research study in Maharashtra, India, long-term outcomes of 258 bilateral congenital and developmental cataract surgeries in 129 children were reported with an average duration of follow-up of 4.4 years. 41 …”