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http://doi.org/10.31288/oftalmolzh20216815

Visual outcome following cataract surgery in children of 2 months to 16 years age: a prospective study in a tertiary eye care center

N. Deepthi Slesser, Nasrin Y., P. Krishna Prasad

Sankar Foundation Eye Institute, Visakhapatnam,  Andhra Pradesh (India)

E-mail: drnasrin95@gmail.com

ЯК ЦИТУВАТИ: Deepthi Slesser N. Visual outcome following cataract surgery in children of 2 months to 16 years age: a prospective study in a tertiary eye care center / N. Slesser Deepthi, Y. Nasrin, Prasad P. Krishna // Офтальмол. журн. — 2021. — № 6. — С. 8-15. http://doi.org/10.31288/oftalmolzh20216815

Background. Childhood cataract is an important cause of blindness in children and imposes a huge socio economic burden on society. 

Purpose. Aim of the study is to identify the visual outcome after cataract surgery in paediatric age group and to study the various factors which influence visual outcome and surgical complications in paediatric cataract surgery. 

Material and Methods. This prospective study conducted at a tertiary Eye care Hospital for the period of September 2016 to February 2017. 30 children who presented with developmental cataract or congenital cataract in the age group of 2months – 16 years included in this study. Visual acuity in children less than 5 years was assessed using picture chart, E charts and Cardiff acuity cards and by snellen’s chart for >5 years age children. Biomicroscopy, Fundus examination, and A scan were done. Children were reviewed every day for first day and then every week for first month and every 3 months for the first year after cataract surgery. 

Results. There were males (56.67%) dominance. Visual Inattentiveness/ defective vision was observed in 29(64.4%) of eyes. 13(33%) children had consanguity. Most of them were bilateral 26 (87%). Nystagmus was found to be the most common6 (20%) associated ocular anomaly. Vision at the time of presentation was less than 6/60 in better eye in 30 eyes (66.66%). Commonest type of cataract was total cataract 20(44.44%), followed by lamellar cataract 10 (22.22%). 45 eyes were operated, and IOL was implanted 73.33% of the eyes. Posterior capsulotomy with or without anterior vitrectomy was done in children less than 8 years of age. Following retinoscopic refraction, children were prescribed bifocal spectacles. Aphakic spectacles were prescribed in needed cases. Visual outcome at the end of 6 weeks was found to be greater than 6/24 in 66.66%. At the end of 12 months, vision greater than 6/24 was 48.88%. Posterior Capsule Opacification (PCO) was thick enough to require capsulotomy in 4 eyes. 3 Children underwent YAG capsulotomy. 1 eye needed surgical membranectomy. Complications other than PCO that was noted in this study were amblyopia which was seen in 5 eyes and optic capture in 2 eyes, anterior synaechiae in 1 eye and vitreous haemorrhage in 1 eye.  

Conclusion. Children less than 8 years who underwent primary posterior capsulotomy with or without anterior vitrectomy showed good visual outcome. PCO is the commonest complication and a major cause for visual obscuration following surgery, though the incidence of PCO has been brought down with modified surgical techniques and newer IOL designs. Children who underwent YAG/surgical capsulotomy had significant visual gain. Children with amblyopia who had strict adherence to occlusion therapy had significant improvement in visual acuity.

Кey words: сhildhood cataract, visual acuity,   YAG capsulotomy, amblyopia 

 

References

1.Taylor HR. Refractive errors – Magnitude of the Need. J Community Eye Health 2000;13:1-2.

2.World Health Organization. Prevention of blindness and deafness.Global Initiative for the Elimination of Avoidable Blindness. WHO Document WHO/PBL/97.61 Rev 2. Geneva: WHO; 2000.

3.Gilbert CE, Canovas R, Hagan M, Rao S, Foster A. Causes of childhood blindness: Results from west Africa, south India and Chile. Eye (Lond) 1993;7(Pt 1):184-8.

4.Dandona L, Williams JD, Williams BC, Rao GN. Population-based assessment of childhood blindness in southern India. Arch Ophthalmol 1998;116:545-6.

5.Rahi JS, Sripathi S, Gilbert CE, Foster A. Childhood blindness in India: Causes in 1318 blind school students in nine states. Eye(Lond) 1995;9(Pt 5):545-50.

6.Giles K, Cristelle D,Y annick B, Fricke OH, Wiedemann P (2016).Cataract surgery with intraocular lens implantation in children aged 5-15 in local anaesthesia:visual outcomes and complications.Pan Afr.Med J;24:200.

7.Ma F, Wang Q, Wang L. Advances in the management of the surgical complications for congenital cataract. Front Med. 2012; 6(4):360–5. 

8.Clare G (2009).Worldwide causes of blindness in chidren, in: Paediatric Ophthalmology: Current Thought and A Practical Guide. Springer, Berlin: 47-60

9.Khanna RC, FosterA, KrishnaiahS, MehtaMK, GogatePM. Visual outcomes of bilateral congenital and developmental cataracts in young children in south India and causes of poor outcome.Indian J Ophthalmol 2013;61:65-70. 1.  Gilbert C. New issues in childhood blindness. Commun Eye Health J. 2001;14:53–56PPMID: 17491932

10.Nikhil R, ShubhiT, AnushreeKA, SudhirT, MadanD. Evaluation of visual outcomes after paediatric cataract surgery in a tertiary eye care hospital in western Maharashtra. J Clin Ophthalmol Res 2016;4:13-8.

11.Thakur J, Reddy H, Wilson ME Jr, Paudyal G, Gurung R, Thapa S, Tabin G, Ruit S. Pediatric cataract surgery in Nepal. J Cataract Refract Surg. 2004; 30(8):1629–35. 

12.BarSela SM, Spierer A. Astigmatism outcomes of scleral tunnel and clear corneal incisions for congenital cataract surgery. Eye (Lond)2006;20:1044 8.

13.Chaudary S et al, Visual outcome of Paediatric Cataract surgery, Nepal J Ophthalmol 2017;Vol 9(18): 143-148

14.Damaris Magdalene et al.  Pediatric cataract blindness management and outcomes in North East India hospital based study Damaris Magdalene 1 ,  Indian Journal of Clinical and Experimental Ophthalmology, January-March,2017;3(1): 112-114

15.Shah MA, Shah SM, Appleware AH, Patel KD, Rehman RM, Shikhange KA, et al. Visual outcome of traumatic cataract in pediatric age group. Eur J Ophthalmol 2012;22:956 63.

16.Brar GS, Grewal DS, Ram J, Singla M, Grewal SP. Square-edge polymethylmethacrylate intraocular lens design for reducing posterior capsule opacification following paediatric cataract surgery: initial experience. Clinical & experimental ophthalmology. 2008 Sep;36(7):625-30. 

17.Hirachan A, Bajracharya K, Rai SK, Bhari AM, Chandra A. Visual outcome of congenital and developmental cataract surgery in Lumbini Eye Institute. Asian Journal of Medical Sciences. 2018 Mar 1;9(2):36-9.

18.Gurung RL, Adhikari S, Shrestha UD, Ruit S. Outcome of Paediatric Cataract Surgery at Tilganga Institute of Ophthalmology, Nepal. Birat Journal of Health Sciences 2018;3(1)5 : 331-337.

Conflict of interest: None.

Funding sources: None

Received 07.07.21