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PubMed1998

[Etiology of contact lens failure in pediatric aphakia. Indications for intraocular lenses?].

UNLABELLED: Due to the low rate of complications, lentectomy and contact lens fitting is the standard treatment for congenital cataract. However, contact lens fitting is not possible in all children. The authors report the main reasons for discontinuation of contact lenses in their patients. METHOD: In 134 consecutive lentectomies of 90 children, the underlying eye diseases and general diseases, the age at operation, compliance of parents and children, and social background were analyzed. RESULTS: Twenty of the 90 children had to discontinue contact lens wearing. Twelve of these children were operated on one eye and 8 on both eyes. Only 2 children showed signs of contact lens complications. In 2 children treatment was stopped because of the poor visual prognosis and in 10 children the parents discontinued contact lens treatment because of a severe handicap of the child (n = 2) or due to misunderstanding and parental noncompliance (n = 8). Six children refused contact lenses without obvious reasons. Among the latter, children 2-4 years of age were at the greatest risk. Children with additional systemic abnormalities frequently developed contact lens intolerance. CONCLUSION: In children with systemic abnormalities and in the case of parental communication and compliance problems, discontinuation of contact lenses has to be expected in up to 30% of cases. In these children and in children who object to contact lenses at the age of 2-4 years, intraocular lens implantation should be considered, especially in unilateral cataract, if successful contact lens treatment is not achievable within 8-12 weeks.

Aphakia, Postcataract↗
PubMed2002

Glaucoma secondary to pars plana lensectomy for congenital cataract.

BACKGROUND: To identify risk factors related to the onset of secondary glaucoma in eyes that have undergone pars plana lensectomy for congenital cataract. METHODS: We investigated intraocular pressure levels after pars plana lensectomy for congenital cataract in 80 eyes of 44 patients who were followed up for at least 36 months. Mean age at the time of pars plana lensectomy was 11+/-18 months. Mean follow-up period was 116+/-57 months. RESULTS: An elevation in intraocular pressure (>20 mmHg) was found in 21 eyes of 12 patients (26%). In 7 of these 21 eyes surgical treatment was required. The incidence of the coexistence of microcornea (or microphthalmos) with congenital cataract was significantly higher in the glaucoma group than that in nonglaucoma group. The final visual acuity in the nonglaucoma group was significantly better than that in the glaucoma group. CONCLUSION: Our results show the importance of careful follow-up of intraocular pressure after pars plana lensectomy for congenital cataract, especially when microcornea (or microphthalmos) is present.

Aphakia, Postcataract↗
PubMed2006

Clinical characteristics and surgical outcomes of pediatric cataract in Taiwan.

PURPOSE: To report treatment of pediatric patients with cataract, and evaluate the efficiency of different surgical interventions. METHOD: This study comprised a consecutive series of pediatric patients with congenital or developing cataract who received surgery between 1993 and 2002 at Chang Gung Memorial Hospital in Taiwan. Patients' demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. RESULTS: Three hundred and ninety-nine eyes of 246 children were included; unilateral cataract was present 21.8% of the eyes. The age at surgery was ranged from 1 to 157 months. Eyes were grouped by surgical interventions performed: Group 1 included 98 eyes that had lensectomy. Group 2 included 89 eyes that had lensectomy and secondary intraocular lens implantation. Group 3 included 212 eyes that had lensectomy with primary intraocular implantation. The mean follow up time was 41.3 months. Finally, 23.1% group 1 patients, 42.1% group 2 patients, and 63.4% group 3 patients achieved visual acuity better than 20/60 (P=0.000). Upon analysis with multifactor regression, age at onset (P=0.011) was the only significant factor related to visual outcome. Complications such as after cataract and glaucoma occurred in 21.6% and 5.8% of all patients, respectively. CONCLUSIONS: Intraocular lens implantation for children with congenital or developing cataract is an effective treatment for visual rehabilitation, even for those patients age 2 years and younger.

Adolescent↗
PubMed2001

Pars plana lentectomy for treatment of congenital cataract.

BACKGROUND: Congenital cataract surgery can be performed using a pars plicata/plana or a limbal approach, if placement of an intraocular lens at the time of cataract removal is not a consideration. Because of the high incidence of secondary cataract formation in children the operation should be combined with capsulotomy and anterior vitrectomy. METHODS: The series consisted of 30 eyes from 20 consecutive children who suffered from congenital cataract and underwent cataract surgery between May 1995 and June 2000. The inclusion criterion was congenital cataract affecting the visual axis. We performed the operations as lens aspiration with anterior and posterior capsulotomy and anterior vitrectomy via the pars plana or plicata. We used contact lenses to rehabilitate vision. All patients received intensive orthoptic and pleoptic treatment. RESULTS: This surgical technique provided in all eyes a clear visual axis. During follow-up of 3 months to 4.5 years, secondary cataract developed in five eyes. Retinal detachment, glaucoma and endophthalmitis did not occur. One patient developed contact lens intolerance and a secondary intraocular lens was placed in the ciliary sulcus. DISCUSSION: Lentectomy via a pars plana or pars plicata approach is a suitable and safe method for treating cataract in children. Our chosen method of lentectomy is an alternative to early implantation of an intraocular lens. It is possible to perform uncomplicated secondary implantation of an intraocular lens in the ciliary sulcus.

Aphakia, Postcataract↗
PubMed1977

A two-year trial of intraocular lenses at the Wilmer Institute.

Using the Binkhorst four-loop intraocular lens, we began a trial of intraocular lens implantation in 1975. We compared the operative and postoperative complications and the visual results of 100 implant cases during a two-year period to those of 100 age-matched aphakic control cases. Although the additional steps of lens implantation resulted in more operative and postoperative complications in the intraocular lens group, the visual results were good and were the same for both groups at an average follow-up of 12 months. Because the long-term follow-up results of implant cases are unknown, we recommend a conservative approach to selection of patients for intraocular lens implantation.

Aged↗
PubMed1978

Prevention of vitreous loss in aphakic keratoplasty.

Controlled aspiration of aqueous before excising the recipient cornea resulted in maintenance of an intact vitreous face during aphakic penetrating corneal transplants in eight of 11 eyes. Vitreous corneal contact or subsequent graft opacification has not occurred in the study group during the observation period.

Anterior Chamber↗
PubMed1978

Stereoscopic acuity measurement in aphakia.

We performed a variety of tests to assess binocular function on monocular aphakic patients wearing contact lenses, monocular pseudophakic patients, bilateral spectacle-wearing aphakic patients, bilateral aphakic contact lens wearers, and bilateral pseudophakic patients. Stereoscopic acuity levels at distance and near when visual acuity was at least 6/12 (20/40) provided the most useful data. Pseudophakic patients and contact lens wearers performed equally well and outperformed spectacle wearers. Implant patients did not have superior stereoscopic acuity.

Aphakia, Postcataract↗
PubMed1978

Prognostic factors of intraocular pressure after aphakic keratoplasty.

In 68 consecutive patients who had undergone aphakic keratoplasty and keratoplasty combined with cataract extraction, patients with pressure problems during the first postoperative week were likely to have chronic pressure problems whether glaucoma was suspected preoperatively or not. Furthermore, those with preoperative glaucoma, even though pressures during the first week were relatively normal, were likely to have reoccurrence of their glaucoma. The preoperative pressures did not indicate which patients would develop persistently increased postoperative pressures. The only patients spared pressure problems were those who had no evidence of glaucoma preoperatively and who also had normal intraocular pressure during the first postoperative week.

Aged↗
PubMed1979

The effect of indomethacin pretreatment on aphakic cystoid macular edema.

In patients treated with oral indomethacin for four weeks after intracapsular cataract extraction, five of 57 eyes (9%) had cystoid macular edema four to six weeks postoperatively as shown by fluorescein angiography. In a control group not treated with indomethacin, 15 of 34 eyes (44%) had cystoid mascular edema. Oral indomethacin, therefore, caused a statistically significant decrease in the incidence of aphakic cystoid macular edema.

Adult↗
PubMed1979

Clinical results in vitrectomy for diabetic traction retinal detachment.

A series of 75 eyes underwent pars plana vitrectomy for progressive diabetic traction retinal detachment of the macula. In all cases, the media was sufficiently clear to allow preoperative macular examination. The overall visual improvement was higher in phakic eyes (80%) than aphakic eyes (72%) and the rate of neovascular glaucoma was less in phakic eyes. The difference was not statistically significant, however. The final visual acuity corresponded to the degree of preoperative visual deterioration. Thus, surgery during the rapidly evolving proliferative and retracting process did not adversely affect the visual success rate when compared to previous reports on longstanding vitreous hemorrhage.

Aphakia, Postcataract↗
PubMed1979

Extended-wear contact lenses and intraocular lenses for aphakic correction.

We evaluated extended-wear soft contact lens use in 128 aphakic eyes of 113 patients, 44 of whom had been unable to wear conventional contact lenses; 116 eyes (91%) have been successfully fitted and have worn the extended-wear lenses without significant complication. Eleven patients were unable to wear the lens or had to be discontinued for transient lens-related problems. In 103 eyes successfully fitted the lens is removed for cleaning less often than monthly. Ninety six of the 116 eyes fitted have visual acuity as good as, or better than, with aphakic correcting spectacles. The results obtained with the extended-wear soft contact lens are similar to those obtained with intraocular lenses, except for the recent high incidence of inflammation seen after intraocular lens insertion when using ethylene-oxide-sterilized lenses.

Adolescent↗
PubMed1979

The microbial flora in extended-wear soft contact-lens wearers.

Of 857 cultures of material collected from the eyelids, conjunctivae, and contact lenses of 51 extended-wear soft-contact-lens wearers, 44 (5%) grew potential pathogens. The aphakic patients wearing contact lenses had fewer recoverable pathogens (24 of 295 or 8%) than a group of preoperative cataract patients (63 of 295 or 21%). On five occasions, positive cultures accompanied clinical symptoms, and on three occasions, repeated cultures grew the same potential pathogen.

Aphakia, Postcataract↗
PubMed1979

Extended-wear contact lenses in 525 aphakic eyes.

Extended-wear contact lenses were fitted to 225 patients with monocular aphakia and 150 with bilateral aphakia. They were observed from three months to three years. Eighty-eight of the 195 eyes fitted with a Softcon lens became red and painful within 14 days during extended wear. The Hydrocurve lens was better tolerated in 55, but many patients had acute congestion, pain, and tearing. Deposits accumulated rapidly on the Sauflon-PW lens. Some 90% of all patients can be fitted successfully with the cellulose acetate butyrate lens or the silicone lens. The silicone coating of the silicone lens is lost or damaged in about 20% of the patients because of excess mucous accumulation.

Aphakia, Postcataract↗
PubMed1979

Cataracts and macular degeneration.

The intraocular lens restores general vision and some degree of independence and mobility to patients with dense cataracts and macular degeneration. The patient, however, must be repeatedly warned that fine central vision, particularly reading, will not be possible after the surgery. An aphakic spectacle leaves such patients a narrow band of vision when superimposed over the macular lesion, and contact lenses are too small for the patient to manage insertion without help.

Aged↗
PubMed1979

Cystoid macular edema in aphakic and pseudophakic eyes.

A prospective fluorescein angiographic study, comparing the incidence of cystoid macular edema in patients 67 years or older after intracapsular cataract extraction with a Binkhorst 4-loop implant, extracapsular cataract extraction with a Binkhorst 2-loop or 4-loop implant, and intracapsular cataract extraction with no implant (controls) was begun at the Bascom Palmer Eye Institute of the University of Miami School of Medicine on May 14, 1974. Excluded from these groups were all patients whom we did not consider to be suitable candidates for lens implant surgery. Fundus fluorescein angiograms were taken four, eight, and 16 to 24 months postoperatively. The surgery was performed by one group of surgeons and the angiograms were read by a group of retinal specialists. The intracapsular cataract extraction-implant and intracapsular-no implant groups had a comparable incidence of cystoid macular edema four, eight, and 16 to 24 months postoperatively. The extra capsular cataract extraction-implant and an intact posterior capsule group had a significantly lower incidence of cystoid macular edema than the intracapsular cataract extraction-implant group 16 to 24 months postoperatively. The differences were less significant at four and eight months. Visual function as measured by visual acuity was 6/12 (20/40) or better in approximately 80% of eyes with angiographic-proven cystoid macular edema.

Aged↗
PubMed1979

Retinal detachment in pseudophakia.

In a series of cataract patients excluding myopic individuals, under age 60 years, and cases in which vitreous loss occurred, retinal detachment was no less frequent after intracapsular cataract extraction and Sputnik iris supported lenses than in controls. Both groups were followed up for a minimum of two years. The detachments predominantly occurred from retinal breaks in areas of the retina that looked normal preoperatively.

Age Factors↗