| Objectives:Children who were diagnosed with simple congenital cataract from 2017 to 2020 in the Fourth Affiliated Hospital of Kunming Medical University and treated with " congenital cataract extraction+posterior capsulotomy+anterior segment vitrectomy+primary intraocular lens implantation " surgery,postoperative follow-up of the study subjects was performed at various time periods,to statistically analyze the changes of some key ocular developmental parameters,such as axial length,corneal curvature,and refraction,in children with congenital cataract before and after treatment,and the incidence of all types of postoperative complications.To deeply explore the safety and efficacy of this procedure in different age groups,especially children under 2 years old with congenital cataract.The purpose of this study is to provide a clinical basis for the timing of surgery,the choice of the timing of intraocular lens implantation,and the calculation of the degree of intraocular lens(IOL)with the reservation of postoperative refraction in children with congenital cataract.MethodsThis subject was a prospective study,and the enrolled children were divided into the following four groups according to their age at surgery according to the law of eye development:group A:4 months ≤ age<2 years;Group B:2 years ≤ age<4 years;Group C:4 years ≤ age<7 years;Group D:7≤age<12 years.The children of the four groups were followed up clinically and prospectively from June to 1 year,and the intraocular pressure,axial,corneal curvature,refractive changes,and incidence of complications were recorded at one,three,six,and one year after surgery,while the children of the matched group could check the naked eye visual acuity,best corrected visual acuity.All data for this study were statistically analyzed using Stata/SE 15.1(statacorp,College Station,USA)statistical software.The number of counted data cases(n)is represented,and the mean of the experimental results was used±Standard deviation(x±s)means that the variables measured were tested for normality of distribution using the Kolmogorov Smirnov test,paired t-test or two independent samples t-test if normally distributed;Rank sum test if not meeting normal distribution;Differences between groups were analyzed by one-way analysis of variance(ANOVA);P<0.05 was taken to indicate a statistically significant difference.Results:1.Postoperative complications:seven of 108(167 eyes)children developed pupillary displacement and distortion,no children developed iris adhesions and pupillary membrane closure,eight(11 eyes)developed posterior cataract and opacification of the optic axial region,and there was no significant difference in the incidence of the above complications among the four groups(all P>0.05);There were no cases of incision leakage,bleeding,endophthalmitis,uveitis,retinal detachment,or glaucoma related adverse events.2.Refraction changes in affected eyes of children with both eyes and monocular eyes:the refraction of the children at 1 month after surgery was taken as the initial postoperative refraction,and the difference between the refraction of the children at 1 year after surgery and the initial refraction of the children in the four groups was statistically significant(all P<0.05),and the refractive difference between the groups,at 1 month after surgery and 1 year after surgery was statistically significant(all P<0.05),However,there was no significant difference in the amount of refractive change(P=0.135,P>0.05).3.Refractive changes in children with unilateral congenital cataract:there was no significant difference between the refraction of healthy eyes at all stages and that of the affected eye and the amount of refractive change in children with unilateral congenital cataract at any stage after surgery(all P>0.05);Diopters all showed a tendency to drift in the direction of myopia,and the myopic drift gradually slowed with age.4.Best corrected visual acuity:a total of 41 of 108(167 eyes)children in the 4 groups could not cooperate to check their visual acuity at the last follow-up examination,all could trace their visual acuity at the last follow-up examination,and the remaining 67(99 eyes)children could cooperate to the international standard visual acuity chart to check their visual acuity.Postoperative best corrected visual acuity(BCVA)was measured in 5 eyes(5.06%)with a BCVA of less than 0.1,17 eyes(17.17%)with a BCVA of 0.1-0.3,17 eyes(17.17%)with a BCVA of 0.3-0.5,30 eyes(30.30%)with a BCVA of 0.5-0.7,and 30 eyes(30.30%)with a BCVA of more than 0.7.5.Postoperative axial changes in affected eyes of children with both eyes and monocular eyes:children in the four groups showed a postoperative increase in axial length at all stages compared with the preoperative axial length,and children in the four groups showed a significant difference in axial length at all stages compared with the preoperative axial length(all P<0.05),and the increase in axial length gradually slowed with age.6.Axial changes in children with unilocular congenital cataract:there was no significant difference between the affected eye axis in children with unilocular congenital cataract and the healthy eye axis in any of the four groups preoperatively,3 months,6 months,or 1 year after surgery(all P>0.05).There was no significant difference in the axial growth between healthy eyes and affected eyes after surgery in children with unilateral congenital cataract(all P>0.05),and the growth rate of healthy eyes was>healthy eyes after surgery in group A or D,while the growth rate was>healthy eyes in group B or C.7.Postoperative keratometry changes in affected eyes of both children and monocular children:the keratometry of the four groups showed different trends from that of the follow-up period,the keratometry of the children in group A was increased compared with that of the children before surgery,but the difference did not reach statistical significance(all P>0.05),and the keratometry of the children in groups B,C,and d after surgery was about the same as that before surgery,And none of the differences were statistically significant(all P>0.05)8.There was no significant difference between healthy eyes and affected eyes at all stages before and after surgery in children with unilateral congenital cataract(all P>0.05),while the increase was approximately consistent between healthy eyes and affected eyes at all stages after surgery with no significant difference(all P>0.05).Conclusions1.Primary IOL implantation is safe and effective in children with congenital cataracts from 4 months to 2 years of age,with a low rate of postoperative complications and a favorable postoperative visual prognosis;2.Among the four groups all children with congenital cataracts showed a tendency toward myopic drift after surgery,which was greater in children aged from 4 months to 2 years,and gradually slowed down with age;3.The postoperative ocular axis and corneal curvature of affected eyes in children with congenital cataract can develop normally,while the development of coordination can be maintained between affected eyes and healthy eyes in children with unilateral congenital cataract,and the prognosis of postoperative vision is better;... |
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