Visual outcome in congenital and developmental unilateral cataracts

Lakshmi, C (2007) Visual outcome in congenital and developmental unilateral cataracts. Masters thesis, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai.


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INTRODUCTION: Cataracts are one of the treatable causes of visual impairment during infancy and childhood. Early surgery and optical correction have resulted in improved visual outcome1 though questions arise concerning patient selection, surgical technique, management of posterior capsule opacification, selection of a suitable IOL design, material and IOL power calculation in view of expected eye growth and management of amblyopia. AIMS AND OBJECTIVES: 1. Analysis of visual outcome in unilateral congenital / developmental cataract in paediatric age group. 2. To document the i. Morphology ii. Aetiology iii. Associated systemic and ocular manifestations 3. To record the 1. Axial length. 2. Refractive error. 3. Keratometry during the period of study and to compare the changes between the two eyes. 4. To analyse the factors influencing visual outcome. MATERIALS AND METHODS: It is a prospective clinical study conducted in Aravind Eye Hospital for a period starting from June 2004 to February 2006. All children with unilateral cataract; both congenital and developmental cataract (between 0 and 15 years of age) were included in the study after informed consent and the children were followed up for a minimum of 6 months post operatively. Inclusion criteria: 1. Unilateral congenital /developmental cataract. 2. Age 0 – 15 years. 3. Extra capsular cataract extraction / IOL surgery (primary / secondary procedure). Exclusion criteria: 1. Informed consent not given. 2. Complicated cataracts/Traumatic cataracts. 3. Confirmed congenital rubella syndrome. 4. Mentally handicapped patients. 5. Congenital bilateral cataract. RESULTS AND OBSERVATIONS: In our study a maximum of 45 patients were taken up of which 5 patients were lost to follow up and the remaining 40 patients were followed up for a minimum period of 6 months and a maximum of 18 months postoperatively (mean 8.35 months). DISCUSSION: Morphological pattern observation in our study shows a preponderance of total cataract, posterior lenticonus and posterior polar cataracts than other types. 22.5% of our patients had posterior lenticonus compared to 18% in the study conducted by Hiles et al5. 47.5% of the children in our study had associated ocular abnormalities which is comparable to the observation of Rahi et al77 which was 47%. Preoperative strabismus was seen in 35% of the children in our study which almost parallels the observation of France TD et al81 (30%). CONCLUSION: 1. Intraocular lens insertion in unilateral cataract gives a better prognosis in visual rehabilitation and is easier for initiating amblyopia management than glasses. 2. Use of intraocular lens in young children is relatively safe if there is correct case selection, proper techniques and timely intervention. 3. More than the unilateral nature the associated preoperative peroperative and postoperative factors influence the visual outcome like strabismus, type of surgery, amblyopia management and timely additional intervention. 4. The most common morphological pattern noticed were total cataracts and posterior lenticonus. 5. Unilateral cataracts tend to be mostly idiopathic. 6. Interocular axial length difference at surgery was not significant and there was no difference in axial length growth or keratometry changes between the affected and normal eye. 7. The maximum axial length growth over the follow up period was in the less than 2 yrs age group. 8. Continued follow up of paediatric IOL patients will address concerns of long term safety.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Visual outcome; congenital; developmental unilateral cataracts
Subjects: MEDICAL > Ophthalmology
Depositing User: Devi S
Date Deposited: 15 Feb 2018 09:18
Last Modified: 15 Feb 2018 09:18

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