Comparing the astigmatic outcome after paediatric cataract surgery with different incisions

Purpose To evaluate the impact of surgical factors such as incision type, number of sutures, and technique of closure on postoperative astigmatism in infants undergoing cataract extraction with or without intraocular lens implantation. Methods The IATS is a multicenter (n=12) clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with intraocular lens (IOL) placement or contact lens aphakic correction. Surgical videos were reviewed with regard to incision type and location, whether the incision was extended, the number of sutures placed, and technique of closure. Corneal astigmatism was measured using a handheld keratometer prior to surgery and at 1 year of age. Results Corneal astigmatism decreased from a mean of 1.92 D at baseline to 1.62 D at age 1 year in the CL group, but remained almost unchanged from 2.00 D to 2.09 D in the IOL group (p=0.023). There was no statistical difference between the amount of corneal astigmatism irrespective of incision type (p=0.214) and no increase in astigmatism with extension of the incision to facilitate IOL placement (p=0.849) at 1 year. The number of sutures and technique of closure did not influence the amount of astigmatism at 1 year. Conclusions At the age of one year following cataract extraction in infants, contact lens correction and the lack of IOL placement are associated with a significant decrease in postoperative corneal astigmatism compared to intraocular lens placement. No other surgical factors considered in this study had a statistically significant impact on corneal astigmatism.

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“…The incisions were closed using non-absorbable sutures, so this decrease in astigmatism was probably not the result of suture absorption. 11 …”

Section: Discussionmentioning

confidence: 99%

“…2–5 Postoperative astigmatism has been studied in pediatric age groups in a few studies using retinoscopy. 6–11 . However, retinoscopy carries with it a degree of subjectivity.…”

Section: Introductionmentioning

confidence: 99%

The effects of surgical factors on postoperative astigmatism in patients enrolled in the Infant Aphakia Treatment Study (IATS)

Wall

Lee

Lynn

et al. 2014

Journal of American Association for Pediatric Ophthalmology and

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“…This can induce large amounts of surgically induced astigmatism in the immediate postoperative period. However, relaxation of a large amount of this suture-induced astigmatism occurs in children having cataract surgery when the wound heals and the Vicryl suture dissolves [57][58][59][60][61][62][63][64][65].…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Intraoperative and Postoperative Complications

Trivedi

Wilson

2021

Essentials of Pediatric Cataract Surgery

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Cataract surgery in children is more difficult and the rate of complications is higher when compared to adult surgery. The rate of intraoperative and postoperative complications is inversely proportional to the age at surgery. In addition to age, surgical technique can influence the rate of complications (e.g., primary intraocular lens implantation vs. aphakia). Higher intraoperative complications in children may be attributed to the common occurrence of an immature iris that results in poor pupil dilation. In addition, the eyes of young children are small and soft. Even small and well-constructed surgical wounds leak when not sutured securely. The anterior capsule in children is highly elastic and difficult to predictably tear into a circular and centered capsulorhexis. Scleral collapse and a formed, non-liquified, vitreous body create the upthrust commonly referred to as posterior vitreous pressure. Postoperative complications are also higher due to an intense inflammatory response and poor compliance to postoperative topical anti-inflammatory drops. The detection of postoperative complications can be challenging because of the difficulties encountered in performing detailed postoperative examinations in children, who may be uncooperative.

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Shenoy¹,

Mittal²,

Gupta³

et al. 2015

American Journal of Ophthalmology

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Comparing the astigmatic outcome after paediatric cataract surgery with different incisions

Abstract: Postoperative astigmatism after paediatric cataract surgery by clear corneal incision was lower compared with scleral incision. However, the difference was small and clinically insignificant.

Cited by 8 publications

References 18 publications

The effects of surgical factors on postoperative astigmatism in patients enrolled in the Infant Aphakia Treatment Study (IATS)

The effects of surgical factors on postoperative astigmatism in patients enrolled in the Infant Aphakia Treatment Study (IATS)

Intraoperative and Postoperative Complications

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