[IOL choice predictability, 1-year visual outcome, and complications after cataract surgery in children]

Abstract

Purpose: To measure the refraction 1year after cataract surgery in children as a function of under-correction of the implant power and to evaluate the visual prognosis and possible therapeutic challenges.

Patients and methods: We conducted a retrospective study of 28 children (38 affected eyes) who underwent unilateral or bilateral cataract surgery with primary intraocular lens implantation over a one-year period of time. The age at the time of surgery was between 1month and 17years.

Results: Ten patients had bilateral cataracts (35%) and 18 patients unilateral (65%). Ten patients were between 0 and 2years of age, 10 patients between 2 and 6years of age, and 8 patients were over 6years old. 72 % of the cataracts were idiopathic. The cataracts were mainly cortico-nuclear (37%). Monocular acuity averaged 0.7 LogMAR (2/10) between 2 and 6years, and 0.2 LogMAR (6.3/10) after 6years. The percentage of under-correction was 31% between 0 and 2years, 12.2% between 2 and 6years, and 2.3% after 6years, for a mean under-correction of 15.2%. The power of the chosen implant after under-correction was 25 diopters on average. One year after surgery, visual acuity averaged 0.2 LogMAR (6.3/10) between 2 and 6years old,and 0.1 LogMAR (8/10) after 6years. The spherical equivalent remained globally stable after surgery (the mean postoperative value was+1.25 diopters). The highest rate of revision surgery occurred in the 0-2year-olds (40%). The most common complication was cellular proliferation (up to 80% of the 0-2year-olds). Only one case of ocular hypertension was noted.

Discussion: It is necessary to apply an under-correction of the intraocular lens power, decreasing with the age of the child. The gain in visual acuity is modest, and the main complication is cellular proliferation.

Keywords: Acuité visuelle; Cataract surgery; Cataracte pédiatrique; Complications; Opération de la cataracte; Pediatric cataract; Primary IOL under-correction; Sous correction de l’implant; Visual acuity.