Long-term follow up study for pediatric implanted eyes

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Long-term follow up study for pediatric implanted
eyes

• Kiyoshi Shimizu MD
• Mitsuhiro Iwata MD
• Makoto Inatomi MD
• Yuki Kamiya MD
• Toshihiko Ueda MD
• Department of Ophthalmology, School of Medicine ,
• Showa University ,Tokyo, Japan.

Authors  have no financial  interest.
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Purpose

• The IOL implantation of pediatric cataract
  patient is still controversial problem in Japan.
• To establish the clinical biocompatibility of IOL
  for pediatric cataract patients, the best
  corrective visual acuity (BCVA), number of
  corneal endothelial cell density, refractive
  changes and clinical findings were determined at
  the final consultation.
• Thirty nine pediatric cataract patients received
  IOL implantation (47 eyes) at the Showa
  University Hospital from 1971 to 2003. The final
  consultation was over 5 years after implantation.

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Subject group A Primary implantation( 41 eyes
) group B Secondary implantation( 6 eyes )
group A group A group B group B
unilateral ( 27 eyes ) bilateral ( 14 eyes ) unilateral ( 4 eyes ) bilateral ( 2 eyes )
cong.-develop. ( 35 eyes ) 16 14 3 2
complicated ( 2 eyes ) 2 0 0 0
traumatic ( 10 eyes ) 9 0 1 0

• Subject 47 pediatric eyes of 39 cases ( male
  26 eyes, female 21 eyes )
• IOL implantation at Showa University Hospital
  during 1972 to 2003
• Mean age 8.604.39 ( 015 years )
• Mean follow up period 10.174.94 years(
  527.01 years )
• 
  A10.105.00 years
• 
  B10.405.50 years

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Operative procedures

• Under general anesthesia
• Biometry (predictable postoperative refraction
  emmetropia or -1D)
• Corneoscleral incision at around 11 oclock
• CCC using visco-elastic materials
• I/A
• IOL(PMMA PC IOL 5.5mm) implantation under
  visco-elastic materials
• Posterior capsulotomy with anterior shallow
  vitrectomy in few cases
• Peripheral iridectomy at 11 oclock
• Corneoscleral sutures
• Subconjuntival injection of antibiotics solution
  with steroid
• There was no complication during the operations

Postoperative managements

• Strong anti-inflammation therapy for 1 month
• Local and general application of steroid and
  antibiotics
• Mydriatics application for 2 weeks

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STUDY

• Best corrective visual acuity (BCVA)
• Number of corneal endothelial cell density
• Refraction
• Severe postoperative complications

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Postoperative BCVA
unilateral bilateral total
Group A cong.- develop. 0.63(50.0) 0.08(71.4) 0.270.41
Group A complicated -0.02(100) / 0.270.41
Group A traumatic 0.19(77.8) / 0.270.41
Group B cong. -develop. 0.42(66.7) -0.08(100) 0.180.46
Group B complicated / / 0.180.46
Group B traumatic -0.08(100) / 0.180.46
Blue numbermean BCVA (logMAR) Black number
of eyes less than logMAR 0.3 (over than 20/40)
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Develovpment of VA
logMAR

group B Secondary
group A Primary
logMAR
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Mean corneal endothelial cell density (mm2) (eyes)
unilateral bilateral total
group A cong.-develop. 3094( 16 ) 3153(14) 2815 646
group A complicated 2515(2) / 2815 646
group A traumatic 1862(9) / 2815 646
group B cong.-develop. 1747(3) 2705(2) 2098827
group B complicated / / 2098827
group B traumatic 2070(1) / 2098827
except 2 eyes of traumatic
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• Corneal endothelial cell density change(mm2)

cells/mm2


Traumatic corneal damage
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Comparison of postoperative refraction between
operative eyes and non-operative eyes of
patients with unilateral operation
-
-
operative eyes
-
non-operative eyes
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Complications

• Secondary cataract (PCO) capsulotomy 31 /47
  eyes
• Pupils shape changes 5/47
• Glaucomanone
• Retinal Detachment none
• Extraction of IOLone eye of lens luxated into
  the vitreous
• IOL findings slight cellular deposits remained
  onto IOL surface in few cases, however no
  abnormal finding of IOL haptics or optics

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Summary

1. BCVA in group B was better than in group A.
   
2. The percentage of BCVA under log MAR 0.3 among
   unilateral (either congenital or developing)
   cataract eyes was lower in Group A than in other
   groups.
3. Corneal endothelial cell density in almost
   patients were over 1500 cells/mm2, except 2
   patients who had traumatic eye injury.
4. The postoperative refraction of unilateral
   cataract in all patients were likely to be
   myopia.
5. PCO was observed in all cases and capsulotomy was
   performed in 31 cases.
6. Severe late complications were not observed.

Conclusions
These results indicate that the IOL implantation
of pediatric cataract patients had good
biocompatibility.