Astigmatism after small-incision dear corneal cataract extraction and intraocular lens implantation in children

Department of Ophthalmology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Journal of Cataract and Refractive Surgery (Impact Factor: 2.72). 10/2004; 30(9):1948-52. DOI: 10.1016/j.jcrs.2004.01.019
Source: PubMed


To investigate the magnitude of postoperative astigmatism in children having cataract extraction with intraocular lens (IOL) implantation through a 3.0 mm superior clear corneal incision.
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
This retrospective chart review comprised all pediatric patients having cataract surgery with IOL implantation through a 3.0 mm clear corneal incision from 1997 to 2002. One hundred two eyes of 75 patients were included. All refractions were performed manually by an experienced pediatric ophthalmologist.
The mean postoperative retinoscopic cylinder in all patients was 0.63 diopter (D) (range 0.0 to 4.50 D) at 1 month, 0.40 D (range 0.0 to 1.75 D) at 6 months, and 0.51 D (range 0.0 to 2.50 D) at 1 year. Patients aged 0 to 36 months at the time of surgery had a mean postoperative cylinder of 0.22 D at 1 month, 0.03 D at 6 months, and 0.21 D at 1 year. Patients between 36 months and 6 years of age at surgery had a mean refractive cylinder of 0.50 D, 0.38 D, and 0.75 D, respectively. Patients older than 6 years at surgery had a mean refractive cylinder of 0.94 D, 0.75 D, and 0.76 D, respectively.
Small-incision clear corneal cataract extraction with IOL implantation in children led to minimal postoperative astigmatism that remained stable over time. Less astigmatism was observed in children having surgery before they were 36 months old.

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    • "The mean astigmatism was 1.75 ± 1.89 D ranging from 0 to 3.5 D (median = 1.0 D). These values are slightly higher than previous reports of Bradfield et al (2004). Their retrospective chart review comprised pediatric patients having cataract surgery with IOL implantation through a 3.0 mm clear corneal incision from 1997 to 2002. "
    M Amon ·
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    ABSTRACT: Introduction: Small incisions in cataract surgery have shown to reduce tissue damage, postoperative inflammation and pain. Objective: To describe in detail the surgical management challenges and clinical results of bimanual micro-incision phacoemulsification cataract surgery in children with congenital cataract. Materials and methods: In 22 eyes of 14 children aged from 11 months to 17 years with congenital cataract, micro-incision cataract surgery with lensectomy, bimanual aspiration or phacoemulsification and implantation of an intraocular lens (SN60WF, Alcon®) was performed under general anesthesia. The visual equivalent obtained with age-related methods, the slit-lamp examination, and refractive outcome were documented in the medical records and were analyzed retrospectively. The patients fulfilled at least 3 months of follow up. Results: In all operated eyes, micro-incision cataract surgery could be performed without serious intra-operative complications. Lensectomy was safely combined with a primary posterior capsulorhexis and anterior vitrectomy in 17 of 22 eyes. Corneal incision length ranged between 2.2 mm and 2.6 mm (mean: 2.3 ± 0.2 mm). No cases of postoperative hypotony and increased inflammation were observed. One eye required surgical removal of the after-cataract 7 months after surgery. Laser capsulotomy for posterior capsular opacification had to be performed in 2 (9 %) eyes. In all other eyes (19/22), visual axis remained clear during follow-up. Conclusion: Micro-incision cataract surgery is a promising alternative to conventional pediatric cataract surgery, since the technique showed to be comparably safe and effective. Longer follow-up examinations will now be performed. Key words: congenital cataract; bimanual micro-incision phacoemulsification.
    Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH 02/2011; 3(5):3-8. DOI:10.3126/nepjoph.v3i1.4270
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    • "Brown, et al. used a 6.25mm scleral-tunnel incision and reported early postoperative astigmatism of up to 8.00D [11]. Our data is comparable to the clear corneal incision data from the study by Bradfield et al., which showed a postoperative astigmatism range of 0-4.50D the first month after surgery [12] however in that study a superior clear corneal incision was used. Some studies have demonstrated that temporal incisions induce less astigmatism than superior wounds [13,14] but others have shown comparable results [14]. "
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    ABSTRACT: To evaluate the early postoperative change in astigmatism in pediatric patients having cataract extraction with intraocular lens implantation using sutured temporal clear corneal incision. A retrospective chart review was performed on all pediatric patients who underwent clear corneal cataract surgery with intraocular lens implantation between 12/01/2005 and 11/30/2006. A total of 31 eyes of 22 patients who underwent temporal clear corneal cataract surgery and intraocular lens implantation were included. The mean patient age at surgery was 6.05 years (range 1.5 months to 17 years). Mean postoperative refractive astigmatism the first day after surgery was 2.35+/-1.37 diopters (D). There was a statistically significant decrease in mean postoperative astigmatism by postoperative week 1 to 1.45 +/- 0.79 D. Mean astigmatism was 1.48 +/- 0.98 D by postoperative months 2-4, which was not a statistically significant change from postoperative day 1. Postoperative astigmatism can be expected after sutured temporal clear corneal surgery in pediatric patients and decreases over time without removal of sutures. The amount of postoperative astigmatism in children requires close follow-up after pediatric cataract surgery.
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