Results of congenital cataract surgery using 2,2 microincision in children before the age of 5 years

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Inès Taamallah-Malek
Amel Chebbi
Imène Zghal
Firas Hachica
Soumaya Ouazzani
Chiraz Boujemaa
Hédi Bouguila
Leila Nacef
Saida Ayed

Abstract

Background: Thanks to the recent advances of the microsurgical techniques, the results of the congenital cataract surgery in children less than 5 years old have considerably improved. However, the age of implantation and the intraocular lens power calculation remain subjects of controversies.
Aim :To evaluate the results of 2.2 mm micro-incision congenital cataract surgery in children less than five years old.
Methods: Forty seven consecutive eyes of 26 children who had dense congenital cataract surgery were included in this retrospective study. All children had had the same surgical procedure: anterior approach through 2.2 mm corneal tunnel, posterior capsulorhexis associated to anterior vitrectomy and a primary foldable intraocular lens implantation. The final evaluation was at the same time anatomical and functional depending on the children age.
Results: The median patient age of the children was of 23 months (6 to 54 months) and the sex ratio was 1.36 (15 boys / 11 girls). The cataract was bilateral in 77.7 % of the cases (21/27 children). The intraocular lens was implanted in the capsular bag in 93.6 % of the cases (44/47 eyes) and in the sulcus in 6.3 % of the cases (3/47 eyes). The postoperative complications were mild: inflammatory reaction limited to the anterior chamber in 17 % of the cases (8/47 eyes), opacification of the visual axis with a reproliferation of the epithelial cells behind the implant was observed in 4.25 % of the eyes (2/47 eyes). We noted no case of intraocular lens decentration or secondary glaucoma. The study of the refraction at last follow up showed a sphere average of 2.73 ± 1.21 diopters and mean astigmatism of 1.51 ± 0.82 diopters. The median best corrected distance visual acuity, evaluated in 12 children, was 5.2/10 ranging from 1/10 to 10/10. The amblyopia was also noted to 12/26 children (46.1 %). Among these children, 11/12 (91.6%) had a delay of surgery and 5/12 (41.6 %) had an unilateral cataract.
Conclusion: Currently the anatomical prognosis of the congenital cataract surgery in children less than 5 years old is getting closer to that of the adult. However, the functional prognosis remains still unpredictable depending mainly on the deadline of surgery which remains very late in our series. Thanks to the improvement of the surgical techniques using microincision in cataract surgery and the new generation of foldable implants, the anatomical and functional prognosis of the congenital cataract have significantly improved.

Keywords:

Congenital cataract, surgery, microincision, posterior capsulorhexis, anterior vitrectomy, intraocular lens, amblyopia

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References

  1. DE LAAGE DE MEUX P. Ophtalmologie pédiatrique. Paris : Ed Masson 2003:205-12.
  2. THOUVENIN D. Prise en charge des cataractes de l'enfant : techniques chirurgicales et choix de l'implant. Jr Fr Ophtalmol 2011;34:198-202.
  3. TRIVEDI RH, PETERSEIM MM, WILSON ME. New techniques and technologies for pediatric cataract surgery. Curr Opinion Ophthalmol 2005; 16 :289-93.
  4. LIN AA, BUCKLEY GE. Update on pediatric cataract surgery and intraocular lens implantation. Curr Opinion Ophthalmol 2010; 21:55-59.
  5. NIHALANI BR, VANDERVEEN DK. Technological advances in pediatric cataract surgery. Semin Ophtalmol 2010;25:271-74.
  6. GRUETERICH M, LACKERBAUER CA, KAMPIK A. Performance of the Acri.Smart 46s intraocular lens in pediatric microincision cataract surgery. J Cataract Refract Surg 2008;34:591-95.
  7. LAM HY, YEN KG. Change in astigmatism after temporal clear corneal cataract extraction in the pediatric population. Open Ophthalmol J 2008;2:43-5.
  8. HUG D. Update on pediatric cataracts and cataract surgery. Int Ophthalmol Clin 2010;50 :107-13.
  9. HAMADA S, LOW S, WALTERS BC, NISCHAL KK. Five-Year experience of the 2-incision push-pull technique for anterior and posterior capsulorhexis in pediatric cataract surgery. Ophthalmology 2006;113:1309-14.
  10. VASAVADA AR, NIHALANI BR. Pediatric cataract surgery. Curr Opin Ophthalmol 2006;17: 54-61.
  11. FORBES BJ, GUO S. Update on the surgical management of pediatric cataracts. J Pediatric Ophthalmol Strabismus 2006; 43:143-51.
  12. CACCIATORI M, ARPA P. Surgical technique for anterior segment surgery in pediatric patients using 25-gauge instruments. J Cataract Refract Surg 2006;43:143-51.
  13. CHEE KY, LAM GC. Management of congenital cataract in children younger than 1 year using 25-gauge vitrectomy system. J Cataract Refract Surg 2009;35:720-24.
  14. TRIVERDI RH, WILSON ME. Posterior capsulotomy and anterior vitrectomy for management of pediatric cataract. In Wilson ME, Triverdi RH, Pandey SK, eds, Pediatric cataract surgery: techniques, complications and management. Philadelphia: Lippincott, Williams and Wilkins 2005:83-92.
  15. GIMBEL HV. Posterior capsulorhexis with optic capture in pediatric cataract and intraocular lens surgery. Ophthalmology 1996;103:1871-5.
  16. Vasavada AR, Trivedi RH. Role of optic capture in congenital cataract and intraocular lens surgery in children. J Cataract Refract Surg 2000;26:824-31.
  17. Faramarzi A. Comparison of two techniques of intraocular lens implantation in pediatric cataract surgery. J Cataract Refract Surg 2009;35:1040-45.
  18. Vasavada AR, Trivedi RH, Singh R. Necessity of vitrectomy when optic capture is performed in children older than 5 years. J Cataract refract surg 2001;27:1185-1193.
  19. TRIVERDI RH, WILSON ME. Acrys of intraocular lens implantation in eyes with pediatric cataract. In Wilson ME, Triverdi RH, Pandey SK, eds, Pediatric cataract surgery: techniques, complications and management. Philadelphia: Lippincott, Williams and Wilkins;2005:139-49.
  20. TRIVEDI RH, WILSON ME, BARTHOLOMEW LR et al. Opacification of the visual axis after cataract surgery and single acrylic intraocular lens implantation in the first year of life.JAAPOS 2004;8:156-64.
  21. WILSON ME, TRIVEDI RH. Choice of intraocular lens for pediatric cataract surgery: Survey of AAPOS members. J Cataract Refract Surg 2007;33:1666-68.
  22. MUFTUOGLU O, KAREL F, DUMAN R. Effect of a yellow intraocular lens on scotopic vision, glare disability, and blue color perception. J Cataract refract Surg 2007;33:658-66.
  23. BEAUCHAMP CL, STARGER DR, WEALKLEY DR et al. Surgical findings with the tinted Acrysof intraocular lens in children. J AAPOS 2007;11:166-69.
  24. HUG D. Intraocular lens use in challanging pediatric cases. Curr Opin Ophthamol 2010;21:345-349
  25. ANDERVEEN DK. Cataract update 2008: all you need to know about your pediatric cataract patients. Binocul Vis Strabismus Q 2008;23:145-58.
  26. MILAZZO S, TURUT P, BREMOND-GIGNAC D. La cataracte de l'enfant et sa stratégie chirurgicale. J Fr Ophtalmol 2011;34:192-97.
  27. THOUVENIN D, NOGUE S, FONTES L, ARNE JL. Résultats fonctionnels à long terme du traitement des cataractes congénitales unilatérales opérés précocement. J Fr Ophthalmol 2003;26:562-9.
  28. Moore DB, Ben Zion I, Neely DE, et al. Accuracy of biometry in pediatric cataract extraction with primary intraocular lens implantation. J Cataract refract Surg 2008;34:1940-7.
  29. MAGLI A, FORTE R, ROMBETTO L. Long-term outcome of primary versus secondary intraocular lens implantation after simultaneous removal of bilateral congenital cataract. Graefes Arch Clin Exp Ophthalmol 2012;:251 : 309-14.