Long-term Follow-up Of Visual Function After Pediatric Cataract Extraction With Intraocular Lens Implantation

Pediatric cataract remains one of the most controversal and challenging disease for most ophthalmologist. Today, with the addition of newer surgical techniques, instrumentation, intraocular lens designs, and materials, cataract extraction with posterior chamber intraocular lens (IOL) implantation in children becomes the preferred method. We studied the clinical records of patients before 13 years of age who had cataract extraction with IOL implantation between June 1996 and 2002 retrospectively, with particular emphasis on long-term visual acuity and binocular function.Method Clinical records of 267 eyes in 173 children aged under 13 years whounderwent cataract extraction with IOL implantation were reviewed in Department of Ophthalmology, Second Hospital of Zhejiang University China between June 1996 and 2002. 35 patients with 54 eyes were included in the study: 6 children with monolateral traumatic cataract, 10 children with monolateral congenital cataract, 19 children with bilateral congenital cataract. Inclusion criteria were age at surgery from 5 months to 150 months. Exclusion criteria were eyes with prematurity; dense corneal scars; vitreoretinopathy; implanted anterior chamber IOL; less than 12 months follow-up. All patients had a surgery using a similar technique. 40 eyes had primary implantation of an IOL in the capsular bag when children's age was up 2 years. 14 eyes had a secondary implantation of an IOL in the sulcus until children' age was 2 years because age at cataract extracted was less than 2 years.Visual acuity was measured with Tumbling E test. The best corrected visual acuity (BCVA) was achieved by experienced optometrist. Visual acuity up to 0.5 was considered "good".Binocular function was examined through fusion and stereo tests. The worth-4-dot test was used to assess sensory fusion and Titmus test was used to assess stereo acuity. Binocular function was considered "good" if there was fusion of the worth-4-dot at distant (5 meters) and near (1/3 meter) and stereo acuity of Titmus test was 100 seconds/arc or better; "poor" if therewas fusion of the worth-4-dot at distant or near or stereo acuity of Titmus test were from 200 to 3000 seconds/arc. Data were analyzed using SPSS 11.0.Result(1)Visual acuity: Overall, BCVA was 0.5 or better in 34 eyes(50.0%), 33.3% of the monolateral traumatic cataracts, 30.3% of the monolateral congenital cataracts and 57.9% of the bilateral congenital cataracts achieved this acuity.(2)good binocular function was achieved in 18 children(38.3%). 50.0% of the children with monolateral traumatic cataract, 10.0% of the children with monolateral congenital cataract and 47.4% of the children with bilateral congenital cataract achieved this.(3)Age at surgery ,extent of cataract .absence of strabismus and nystagmus were significant for good visual acuity(/KO. 050). Age at surgery, absence of strabismus and nystagmus , good visual acuity were significant for good binocular function. (p<0. 050)ConclusionGood visual acuity and binocular function can be achieved after pediatric cataract extraction and intraocular lensimplantation.The presence of strabismus or nystagmus decreases the chance of achieving a good visual function. The treatment of strabismus are essential.