Cataract surgery with intraocular lens implantation in children aged 5-15 in local anaesthesia: visual outcomes and complications

Abstract

The aim of this study was to report feasibility, the visual outcomes and complications of pediatric cataract surgery with primary intraocular lens implantation in children aged 5 to15 years in local anesthesia. This retrospective interventional case series included 62 eyes from 50 children who underwent pediatrc cataract surgery with primary intraocular lens implantation at the Mana eye Clinic Nkongsamba between 2006 and 2015 Main outcome measures were: best-corrected post operative visual acuity, and intraoperative and postoperative complications. Mean age at surgery was 10.18 ± 3.21 years. Mean follow up length was 15.75 ± 3.36 weeks. Etiology included: 10 congenital cataracs (16.12%). 35 developmental cataracts (56.45%) and 17 traumatic cataracts (27.41%). The mean preoperative BCVA was logMAR 1.19 ± 0.33. (range 0.6-2.3). After cycloplegia refraction 2 weeks after surgery, the mean postoperative BCVA was log MAR 0.58 ± 0.88 ( range 0.5-1.8). The mean implanted IOL power was 22.01 ±3.16 D. IOL was succefuly implanted in 54 eyes (87.07%). Eight eyes (9.67%) were left aphakic. Increase in BCVA of 4 logMAR lines and above was recorded in 27 patients (43.55%). Intraoperative complications included: 4 posterior capsule holes with vitrous lost, 3 lenses subluxation and 1 case of iris dialyse. Late postoperative complications included: posterior capsular opacity which occurred in 16 patients, 3 posterior synechia, 2 retinal detachment. Peribulbar anaesthesia can be considered as a viable option in selected patients presenting developmental cataract undergoing cataract surgery in developing countries. Effort should be made to improve the early identification of congenital cataract and its early surgical intervention and prompt optical rehabilitation to prevent amblyopia.

Factors affecting the visual outcome of pediatric cataract surgery: a hospital based prospective study in eastern Nepal

“…Currently cataract remains one of the most important causes of treatable blindness in children (Giles et al, 2016). …”

The Comparison of Visual Acuity After Congenital Cataract Surgery between Children ≤2 Years and >2-17 Years

“…The presence of visual deprivation caused the rate of vision in children to get worse, the incidence of PCO was the final complication that caused vision to get worse. 16 Many factors that affected visual acuity at 3 months and 6 months follow-up at >2-17 years of operation were better than surgery in age age ≤2 years. A previous study explained that the mean visual acuity extracted at 6-month operating age was smaller than the 3-month operating age.…”

“…Many factors influence, among others: cataract type, type of surgery, intraocular lens type, age of operation, presence or absence of postoperative uveitis, and pre-operative visual acuity. 16 IOL implantation during congenital cataract surgery was very mandatory because other methods for visual rehabilitation such as glasses and contact lenses were less suitable for use. The presence of visual deprivation caused the rate of vision in children to get worse, the incidence of PCO was the final complication that caused vision to get worse.…”

Effect of pterygopalatine blockade on perioperative stress and inflammatory outcomes following paediatric cataract surgery

“…Furthermore, no traditional education of ophthalmic blocks in children exists in residency programs of anesthesiology. The use of retrobulbar blockade in pediatric patients can also contribute to a sharp shallowing of the anterior chamber during surgery, thus worsening conditions for surgical intervention 17…”