Outcome after cataract extraction combined with intraocular lens implantation in children with bilateral congenital cataract: a five-year follow-up

Objective

To observe the 5-year outcomes and complications after cataract extraction combined with intraocular lens implantation in children with bilateral congenital cataract.

Methods

An observational case series study was performed.A total of 72 children (144 eyes), aged 2 to 7 years, who received intraocular lens (IOL) implantation combined with posterior continuous curvilinear capsulorhexies and anterior vitrectomy after cataract extraction for bilateral congenital cataract in The First Affiliated Hospital of Zhengzhou University from January 2007 to January 2012 were enrolled.All the patients underwent refractive correction and amblyopia training two weeks after the second operative eye underwent surgery.The patients were divided into 2-3 years old group (64 eyes), 4-5 years old group (48 eyes) and 6-7 years old group (32 eyes) according to their age at surgery.The preoperative and postoperative best corrected visual acuity (BCVA), refraction, axial length, corneal curvature, binocular visual function and postoperative complications were observed during the 5-year follow-up period.The influence of age at surgery on postoperative BCVA in one eye at the final follow-up visit was analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of The Affiliated First Hospital of Zhengzhou University (No.2020-KY-219), and written informed consent was obtained from guardians of the subjects before treatment.

Results

The mean myopic shift was -2.10(-2.90, -1.90), -1.73(-2.50, -2.10) and-0.52(-2.00, -0.28)D in the 2-3 years old group, 4-5 years old group and 6-7 years old group, respectively, and the axial elongation in the three groups was (1.41±0.32), (0.96±0.51), and (0.52±0.26)mm, respectively, and the differences among the three groups were statistically significant (H=19.85, P<0.01; F=13.24, P<0.05).There was no statistically significant difference in preoperative and postoperative corneal curvature among the three groups (all at P>0.05).The BCVA was significantly improved in all the eyes after operation, and a certain binocular visual function was obtained, and the visual function in the 2-3 years old group was better than that of 4-5 years old group and 6-7 years old group (all at P<0.05).The BCVA at the end of following-up was 0.3 or better in 116 eyes (80.56%), and was better than 0.8 in 28 eyes (19.44%).The regression analysis results showed that children younger at surgery had better visual outcome (postoperative BCVA=0.959-0.104 operative age of patient; R²=0.539, P<0.01).

Conclusions

The recovery of visual function in children with binocular congenital cataract is related to the age at operation.The younger the age at operation is, the better the recovery of visual function will be.Timely, systematic and standardized refractive correction, amblyopia treatment and binocular visual function training after operation are helpful to the development and reconstruction of visual function.