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NR 10-12/2008
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Assessment of visual
function in children with foldable intraocular lens implants
Ocena narządu wzroku u
dzieci z wszczepem zwijalnej soczewki wewnątrzgałkowej
Alina Bakunowicz-Łazarczyk, Dorota
Średzińska-Kita, Małgorzata Mrugacz, Michał Szumiński
From the Department of Children’s Ophthalmology Children
Teaching Hospital, Białystok, Poland
The Head of Department: Professor Alina Bakunowicz-Łazarczyk,
MD, PhD |
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| Summary: |
Purpose: The aim of
the current study was to assess the results of cataract
surgery involving implantation of foldable intraocular
lenses in children.
Material and methods: Cataract surgery with
foldable lenses was performed in 60 children.
Postoperative visual acuity, endothelial cell density,
corneal pachymetry, postoperative astigmatism and
complications were analyzed.
Results: Quick visual recovery was observed in
children after surgery. Only a few postoperative
complications occurred.
Conclusions: The foldable intraocular lenses are
easy to insert. The surgical procedure with foldable
lens implantation is a useful and safe method of
treatment. |
| Słowa kluczowe: |
operacja zaćmy, wszczep
soczewki zwijalnej, dzieci. |
| Key words: |
cataract surgery, foldable
intraocular lens implants, children. |
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Introduction
Small incision cataract surgery with foldable lens implants is a
great progress in the operative techniques. Advantages include a
decrease in postoperative astigmatism, a reduction in the
incidence of inflammatory reactions and quick improvement in
visual acuity postoperatively (1,2,3,4,5,6 ).
The study objective was to assess the organ of sight in children
with foldable intraocular lens implants in various types of
cataract.
Patients and methods
In the years 2001-2006, in the University Hospital Department of
Children’s Ophthalmology in Białystok, 300 cataract surgeries
were performed. Foldable intraocular lenses were implanted in 60
patients with various types of cataract, in age of 3 months – 18
years (26 girls and 34 boys). All the patients were followed up
after 24h, 7 days and one month postoperatively.
In the study patients, 20 had unilateral congenital cataract, 20
had unilateral posttraumatic cataract and in 20 unilateral
postinflammatory cataract was diagnosed, including 8 with
underlying toxoplasmosis, 6 with toxocarosis and 6 having
idiopathic uveitis.
Prior to surgery, the children underwent a complete ophthalmic
examination, autorefractometry, keratometry, pachymetry (above 6
years of age), A- and B-scan eyeball ultrasonography.
The SRK II method was used to calculate the implant power. The
power was smaller by 20% in children under 2 years of age, by
15% in children 2-4 years old and by 10% in 4 to 8-year-old
patients, as compared to the standard values.
Visual acuity was examined prior to surgery in children under 3 years
old. In 10 patients we failed to determine visual acuity due to
age. Ten eyes had visual acuity ranging between the correct
projection and 2/50, 24 eyes had 3/50-5/50 and 16 eyes
5/25-5/16.
In children over 6 years old, pachymetry (Topcon Sp 2000P) was
performed before and 1 day and one month after surgery.
Astigmatism was assessed before and 1 month after surgery. The
incidence of intraoperative and postoperative complications was
estimated.
The t-Student test and Wilcoxon’s pair sequence test were used
for statistical analysis (level of significance at p<0.05).
All patients were operated under general anesthesia. Corneal
incision (approximately 3.5 mm) was performed. Following
administration of a viscoelastic agent to the anterior chamber
of the eyeball, the anterior lens capsule was opened by
circumferential incision with a capsulotome. Lens masses were
irrigated and aspirated by using an Aspimat apparatus. Children
under 5 years old underwent posterior capsulotomy with anterior
vitrectomy. A one-piece foldable lens (AcrySof) was implanted
through a corneal incision. Then, the viscoelastic agent was
aspirated and the postoperative wound was closed with a 10/0
suture.
Results
Visual acuity improved within a month after surgery and remained
at the same level throughout the further follow-up period. In
children with congenital cataract, visual acuity improved to
5/50-5/8cc (light sensitivity prior to surgery – 5/50), with
posttraumatic cataract to 5/10-5/5 cc (before surgery – 5/25)
and with postinflammatory cataract to 5/10-5/5 cc (prior to
surgery 5/50-5/16).
One day after surgery, thickness of the central cornea was
significantly higher than before operation. However, one month
after the surgery, the corneal thickness returned to the
preoperative level (mean 524.5 μm). Measurements of the central
corneal thickness have been presented in Table I.
Corneal endothelial density was assessed before operation and
one month after the procedure. The patients showed a 4-10%
reduction in endothelial cell density after the procedure
(p<0.003).
Assessment of astigmatism before and one month and 3 months
after the procedure revealed no significant change in the defect,
which ranged from -1.5 to 1.5 D cyl (mean +0.5 D cyl), p>0.7.
No intra-operative complications were observed.
In the postoperative period, 4 patients with posttraumatic
cataract were found to have fibrinous exudate, which underwent
resorption due to a local treatment, whereas 7 patients had
pigment deposits on the lens. No patient developed intraocular
pressure or retinal complications.
Discussion
The major purpose of cataract surgery in children is to obtain
the state allowing proper vision and/or facilitating effective
convalescence. Implantation of an artificial lens is the optimal
correction mode in children with aphakia (7,8). Advances in
operative techniques and the use of foldable lenses in the
treatment of cataract have reduced postoperative complications
(9,10,11,12).
In all our patients the operative procedure significantly
improved visual acuity. The findings resemble those of other
authors (13), who observed the most numerous group of patients
with visual acuity of 5/10 and better, postoperatively. In our
material, the least improvement in visual acuity was observed in
the group of children with congenital cataract, due to fixed
amblyopia and late notification.
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Corneal thickness and
endothelial cell density are the essential factors that affect
vision. We found no significant change in the corneal thickness
in the late postoperative period, which is consistent with
observations of other authors (13). The increase in the corneal
thickness in an early postoperative period, caused by operative
endothelial damage, is only transitory and thus corneal
hydration and transparency disorders are temporary. Only a
slight reduction was noted in corneal endothelial cell density,
which indicates that the surgical method is safe. Our results
are in agreement with the findings of other authors, who
demonstrate that application of the small incision foldable lens
technique does not cause a considerable reduction in endothelial
cell density (14). Slight postoperative astigmatism is another
factor in favor of the foldable lenses. In our group, in the
late postoperative period, the defect was +0.5 Dcyl on average.
Similar data have been reported by Japanese authors, which thus
confirms the effectiveness of the small incision technique (14).
A decrease in the number of intra- and post-operative
complications is also a great advantage. In the study group, we
found single cases of fibrinous exudate in the anterior chamber
and pigment deposits on the lens. This is consistent with the
findings of other researchers who did not reveal retinal
complications or intraocular pressure postoperatively (12).
Conclusions
1. Foldable lens implantation is a safe surgical procedure in
the case of various types of cataract in children.
2. The incidence of postoperative complications was not higher,
as compared to other operative methods.
References:
1. Bhattacharjee H, Bhattacharjee K, Medhi J: Visual performance:
Comparison of foldable intraocular lenses. J Cataract Refract
Surg 2006, 32, 451-455.
2. Lubiński W, Palacz O, Łąk K, Barnyk K, Szmatłoch K: Kliniczna
ocena zastosowania aplikatora AMO PhacoFlex II SofTip Insertion
System w technice implantacji silikonowych soczewek
wewnatrzgałkowych. Klin Oczna 2002, 104, 362-365.
3. Leydolt C, Davidovic S, Sacu S, Menapace R, Neumayer T, Prinz
A, Buehl W, Findl O: Long-term effect of 1-piece and 3-piece
hydrophobic acrylic intraocular lens on posterior capsule
opacification: a randomized trial. Ophthalmology 2007, 114,
1663-1669.
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Karczewicz D: Visual function and late complications after
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capsulotomy and intracapsular foldable intraocular lens
implantation. Klin Oczna 2005, 107, 611-614.
5. Gierek-Ciaciura S: Ocena soczewek MemoryLens w materiale
własnym. Klin Oczna 2002, 104, 366-368.
6. Wilczynski M, Drobniewski I, Synder A, Omulecki W: Evaluation
of early corneal endothelial cell loss in bimanual microincision
cataract surgery (MICS) in comparison with standard
phacoemulsification. Eur J Ophthalmol 2006, 16, 798-803.
7. Astle WF, Lngram AD, Isaza GM, Echeverri P: Paediatric
pseudophakia: analysis of intraocular lens power and myopic
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8. Wilson ME, Trivedi RH: Choice of intraocular lens for
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Refract Surg 2007, 33, 1666-1668.
9. Kanigowska K, Grałek M, Klimczak-Ślączka D, Hautz W,
Chipczyńska B: Wpływ powikłań śródoperacyjnych na fiksację
sztucznej sztywnej soczewki wewnątrzgałkowej w operacjach zaćmy
u dzieci. Klin Oczna 2006, 108, 401-404.
10. Beauchamp CL, Stager DR, Weakley DR, Wang X, Felius J:
Surgical findings with the tined AcrySof intraocular lens in
children. J AAPOS 2007, 11, 166-169.
11. Trivedi RH, Wilson ME, Facciani J: Secondary intraocular
lens implantation for pediatric aphakia. J AAPOS 2005, 9,
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12. Wilson ME, Elliott L, Johnson B, Peterseim MM, Rah S, Werner
L, Pandey SK: AcrySof acrylic intraocular lens implantation in
children: clinical indications of biocompatibility. J AAPOS
2001, 5, 377-380.
13. Amon M, Menapace R, Radax U: Endothelial cell density and
corneal pachymetry after no-sitch, small incision cataract
surgery. Doc Ophthalmol 1992, 81, 301-307.
14. Oshima Y, Tsujikawa K, Oh A et al.: Comparative study of
intraocular lens implantation throgh 3,0 mm temporal clear
corneal and superior scleral tunnel self-sealing incisions. J
Cataract Refract Surg 1997, 23, 347-353.
Praca wpłynęła do redakcji 22.06.2008 r. (1059)
Zakwalifikowano do druku 20.10.2008 r.
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