Timing and approaches in congenital cataract surgery:a four-year,two-layer randomized controlled trial

AIM：To compare visual prognoses and postoperative adverse events of congenital cataract surgery performed at different times and using different surgical approaches.METHODS：In this prospective,randomized controlled trial,we recruited congenital cataract patients aged 3 mo or younger before cataract surgery.Sixty-one eligible patients were randomly assigned to two groups according to surgical timing：a 3-month-old group and a 6-month-old group.Each eye underwent one of three randomly assigned surgical procedures,as follows：surgery A,lens aspiration（I/A）;surgery B,lens aspiration with posterior continuous curvilinear capsulorhexis（I/A＋PCCC）;and surgery C,lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy（I/A＋PCCC＋A-Vit）.The long-term best-corrected visual acuity（BCVA） and the incidence of complications in the different groups were compared and analyzed.RESULTS：A total of 57 participants（114 eyes） with a mean follow-up period of 48.7 mo were included in the final analysis.The overall log MAR BCVA in the 6-month-old group was better than that in the 3-month-old group（0.81±0.28 vs 0.96±0.30;P=0.02）.The overall log MAR BCVA scores in the surgery B group were lower than the scores in the A and C groups（A：0.80±0.29,B：1.02±0.28,and C：0.84±0.28;P=0.007）.A multivariate linear regression revealed no significant relationships between the incidence of complications and long-term BCVA.CONCLUSION：It might be safer and more beneficial for bilateral total congenital cataract patients to undergosurgery at 6 mo of age than 3 mo.Moreover,with rigorous follow-up and timely intervention,the postoperative complications in these patients are treatable and do not compromise visual outcomes.

Morphological changes in the iridocorneal angle and their relationship with intraocular pressure after infantile cataract surgery

·AIM:To evaluate morphological changes in the iridocorneal angle after pediatric cataract surgery.·METHODS:Children who underwent primary infantile cataract surgery were included and 64 eyes from 41 children,including 18 with unilateral cataracts(18 eyes)and 23 with bilateral cataracts(46 eyes)were examined.All patients underwent two gonioscopic examinations to evaluate the iridocorneal angle,before the primary lens removal and before the secondary intraocular lens implantation.The anatomical changes in the iridocorneal angle and the relationship between intraocular pressure(IOP)and iridocorneal angle changes were also analyzed.·RESULTS:The iridocorneal angle was wide in 64 eyes before and after surgery.The trabecular meshwork pigmentation,number of iris processes in every quadrant of the iridocorneal angle,and the width of the ciliary body band in the superior and inferior quadrants at the second gonioscopic examination were significantly increased compared to those at the first examination(P<0.001,P<0.05,P<0.05.and P<0.05,respectively).IOP gradually increased at 1 mo after operation,and returned to the preoperative level at 3 mo.However,IOP still increased significantly at 6 and 12 mo.·CONCLUSION:The main changes after pediatric cataract surgery include an increase in trabecular meshwork pigmentation and number of iris processes,IOP gradually increase and has positive correlation with trabecular meshwork pigmentation and anterior insertion of iris process.

Management of cataract surgery in Lowe syndrome

AIM: To evaluate the ophthalmic and anesthesiologic management of cataract surgery in children with Lowe syndrome receiving lens removal, the development and management of secondary glaucoma.METHODS: This retrospective case series included 12 eyes of 6 children with genetically verified Lowe syndrome receiving cataract removal. Information regarding the type and duration of surgery and total anesthesia time were recorded. Additionally, intra-and postoperative complications were noted as well as clinical examinations such as visual acuity and funduscopy. RESULTS: All children received simultaneous bilateral cataract surgery at the mean age of 8.98±3.58 wk. Lensectomy combined with posterior capsulotomy and anterior vitrectomy was performed in all children. The mean time for cataract surgery per eye was 35.83±8.86 min, whereas the total time of surgery was 153.33±22.11 min. The mean extubation time and duration at recovery room was 42.33±22.60 min and 130.00±64.37 min, respectively. During surgery, a decrease of oxygen saturation below 93% was found in only one child. During the postoperative followup, nystagmus(6 children) and strabismus(5 children) was commonly found in contrast to no case of visual axis opacification. Secondary glaucoma developed in five eyes of three children, which was treated with topical eye drops in only one child. A trabeculectomy was performed in both eyes of one child, whereas removal of syechia and an iridectomy in one eye of one child. CONCLUSION: Bilateral simultaneous cataract surgery under general anesthesia is a safe surgical procedure in Lowe syndrome children. The glaucoma screening with intraocular pressure measurements is crucial in the postoperative management of Lowe syndrome patients to avoid additional visual impairment.