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Refractive outcomes of cataract surgery in primary congenital glaucoma.

ABSTRACT: AIM:To evaluate refractive outcomes of cataract surgery with intraocular lens (IOL) implantation in operated eyes of primary congenital glaucoma (PCG). DESIGN:A retrospective case-control study. METHODS:Patients of PCG who developed cataract following trabeculectomy with trabeculotomy were recruited. Preoperative biometry was recorded and refractive outcomes of the patients in terms of spherical equivalent (SE) and prediction error were noted at 3 and at 12 months following surgery. The refractive outcomes were compared with non-glaucomatous eyes of children in similar age group who underwent lens aspiration with IOL implantation (controls). RESULTS:The median age of the children with PCG (n?=?31) at the time of cataract surgery was 60 months, similar to controls (n?=?29); 48 months (p?=?0.3). The SE in PCG eyes at 12 months was comparable to controls (p?=?0.18). The prediction error (postoperative SE?-?predicted SE) at 3 months (p?=?0.018) and at 12 months (p?=?0.03) among PCG eyes was higher and more myopic compared with controls. The range of prediction error at 12 months in PCG eyes was -?8.6 to?+?5.8?D (median?-?2.0?D), whereas in controls it was -?4.2 to?+?6.3?D (median?+?0.5?D). For each mmHg intraocular pressure (IOP) increase there was 0.42?mm increase in axial length among PCG eyes and a 0.24?mm increase among controls (p?

SUBMITTER: Khokhar S

PROVIDER: S-EPMC6461842 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Refractive outcomes of cataract surgery in primary congenital glaucoma.

Khokhar Sudarshan S Yadav Dev D Gupta Shikha S Sihota Ramanjit R Chaurasia Abadh Kishore AK Gupta Amisha A Gupta Viney V

Eye (London, England) 20181031 4

<h4>Aim</h4>To evaluate refractive outcomes of cataract surgery with intraocular lens (IOL) implantation in operated eyes of primary congenital glaucoma (PCG).<h4>Design</h4>A retrospective case-control study.<h4>Methods</h4>Patients of PCG who developed cataract following trabeculectomy with trabeculotomy were recruited. Preoperative biometry was recorded and refractive outcomes of the patients in terms of spherical equivalent (SE) and prediction error were noted at 3 and at 12 months following ...[more]

PMID: 30382237

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Project description:BackgroundThis study aimed to identify the incidence of and risk factors for postoperative glaucoma-related adverse events at various time points after congenital cataract surgery.MethodsThis retrospective cohort study enrolled 259 eyes from 174 patients (surgical age ≤ 7 years) who underwent congenital cataract surgery. All surgical procedures were conducted at the Eye Hospital of Wenzhou Medical University between May 2011 and March 2019. Patients were classified into group 1 [primary intraocular lens (IOL) implantation, N = 111 eyes], group 2 (secondary IOL implantation, N = 85 eyes), and group 3 (no IOL implantation, N = 63 eyes). We recorded demographic factors and incidence and risk factors for glaucoma-related adverse events.ResultsGlaucoma-related adverse events occurred in 21 (8.1%) eyes, whereas 27 (10.4%) eyes developed steroid-induced ocular hypertension. The percentage of glaucoma-related adverse events was 0%, 1.2%, 1.2%, 1.6%, 4.0%, and 8.9% at 1 month, 6 months, 1 year, 2 years, 3 years and 4 years after surgery, respectively. Sixteen (18.8%), five (7.9%), and zero eyes developed glaucoma-related adverse events in groups 2, 3, and 1, respectively. Family history of congenital cataract [hazard ratio (HR), 50.463; 95% confidence interval (CI), 7.051-361.139; P < 0.001], preoperative central corneal thickness (CCT) [HR, 1.021; 95% CI, 1.009-1.034; P = 0.001], preoperative horizontal corneal diameter (HCD) [HR, 3.922; 95% CI, 1.558-9.804; P = 0.004], and preoperative lens thickness (LT) [HR, 3.745; 95% CI, 1.344-10.417; P = 0.012] were identified as predictors of postoperative glaucoma-related adverse events.ConclusionsFamily history of congenital cataract, thicker preoperative CCT, smaller preoperative HCD, and thinner preoperative LT are the main risk factors of postoperative glaucoma-related adverse events. Regular monitoring of children after cataract surgery with these risk factors may help ophthalmologists detect susceptible individuals and provide timely interventions in the clinic.

Project description:ImportanceApproximately 2 million cataract operations are performed annually in the US, and patterns of cataract surgery delivery are changing to meet the increasing demand. Therefore, a comparative analysis of visual acuity outcomes after immediate sequential bilateral cataract surgery (ISBCS) vs delayed sequential bilateral cataract surgery (DSBCS) is important for informing future best practices.ObjectiveTo compare refractive outcomes of patients who underwent ISBCS, short-interval (1-14 days between operations) DSBCS (DSBCS-14), and long-interval (15-90 days) DSBCS (DSBCS-90) procedures.Design, setting, and participantsThis retrospective cohort study used population-based data from the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry. A total of 1 824 196 IRIS Registry participants with bilateral visual acuity measurements who underwent bilateral cataract surgery were assessed.ExposuresParticipants were divided into 3 groups (DSBCS-90, DSBCS-14, and ISBCS groups) based on the timing of the second eye surgery. Univariable and multivariable linear regression models were used to analyze the refractive outcomes of the first and second surgery eye.Main outcomes and measuresMean postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) after cataract surgery.ResultsThis study analyzed data from 1 824 196 patients undergoing bilateral cataract surgery (mean [SD] age for those <87 years, 70.03 [7.77]; 684 916 [37.5%] male). Compared with the DSBCS-90 group, after age, self-reported race, insurance status, history of age-related macular degeneration, diabetic retinopathy, and glaucoma were controlled for, the UCVA of the first surgical eye was higher by 0.41 (95% CI, 0.36-0.45; P < .001) letters, and the BCVA was higher by 0.89 (95% CI, 0.86-0.92; P < .001) letters in the DSBCS-14 group, whereas in the ISBCS group, the UCVA was lower by 2.79 (95% CI, -2.95 to -2.63; P < .001) letters and the BCVA by 1.64 (95% CI, -1.74 to -1.53; P < .001) letters. Similarly, compared with the DSBCS-90 group for the second eye, in the DSBCS-14 group, the UCVA was higher by 0.79 (95% CI, 0.74-0.83; P < .001) letters and the BCVA by 0.48 (95% CI, 0.45-0.51; P < .001) letters, whereas in the ISBCS group, the UCVA was lower by -1.67 (95% CI, -1.83 to -1.51; P < .001) letters and the BCVA by -1.88 (95% CI, -1.98 to -1.78; P < .001) letters.Conclusions and relevanceThe results of this cohort study of patients in the IRIS Registry suggest that compared with DSBCS-14 or DSBCS-90, ISBCS is associated with worse visual outcomes, which may or may not be clinically relevant, depending on patients' additional risk factors. Nonrandom surgery group assignment, confounding factors, and large sample size could account for the small but statistically significant differences noted. Further studies are warranted to determine whether these factors should be considered clinically relevant when counseling patients before cataract surgery.

Project description:ImportanceThe p.Asp67Tyr genetic variant in the GJA3 gene is responsible for congenital cataracts in a family with a high incidence of glaucoma following cataract surgery.ObjectiveTo describe the clinical features of a family with a strong association between congenital cataracts and glaucoma following cataract surgery secondary to a genetic variant in the GJA3 gene (NM_021954.4:c.199G>T, p.Asp67Tyr).Design, setting, and participantsThis was a retrospective, observational, case series, genetic association study from the University of Iowa spanning 61 years. Examined were the ophthalmic records from 1961 through 2022 of the family members of a 4-generation pedigree with autosomal dominant congenital cataracts.Main outcomes and measuresFrequency of glaucoma following cataract surgery and postoperative complications among family members with congenital cataract due to the p.Asp67Tyr GJA3 genetic variant.ResultsMedical records were available from 11 of 12 family members (7 male [63.6%]) with congenital cataract with a mean (SD) follow-up of 30 (21.7) years (range, 0.2-61 years). Eight of 9 patients with congenital cataracts developed glaucoma, and 8 of 8 patients who had cataract surgery at age 2 years or younger developed glaucoma following cataract surgery. The only family member with congenital cataracts who did not develop glaucoma had delayed cataract surgery until 12 and 21 years of age. Five of 11 family members (45.5%) had retinal detachments after cataract extraction and vitrectomy. No patients developed retinal detachments after prophylactic 360-degree endolaser.Conclusions and relevanceThe GJA3 genetic variant, p.Asp67Tyr, was identified in a 4-generation congenital cataract pedigree from Iowa. This report suggests that patients with congenital cataract due to some GJA3 genetic variants may be at especially high risk for glaucoma following cataract surgery. Retinal detachments after cataract extraction in the first 2 years of life were also common in this family, and prophylactic retinal endolaser may be indicated at the time of surgery.

Project description:Importance:Primary epiretinal membrane (ERM) is a common retinal disorder with a prevalence of 4% to 18.5%. Although ERM and cataracts commonly occur together, to our knowledge, no studies have investigated the outcome of cataract surgery alone in this setting. Objective:To analyze the visual outcome and cystoid macular edema risk with cataract surgery in eyes with primary ERM. Design, Setting, and Participants:In this retrospective clinical database study, data were collected from July 2003 to March 2015 from 8 locations in the United Kingdom. Cataract surgery data of 217?557 eyes were extracted from the electronic medical record of the UK National Health Service. After exclusion of 57?561 eyes with combined surgery, prior vitrectomy, copathology, and complications, 812 eyes with primary ERM and 159?184 reference eyes were analyzed. Main Outcomes and Measures:We report on visual acuity (VA), the incidence of cystoid macular edema, and the need for ERM surgery. Results:The mean (SD) age of patients in the ERM group was 73.7 (9.23) years, and 395 of 812 were men (46.8%). The mean (SD) age of patients in the reference group was 74.4 (12.19) years, and 65?265 of 159?184 were men (41%). Epiretinal membrane eyes assessed at 4 to 12 weeks postoperatively gained 0.27 (0.32) logMAR (approximately?3 Snellen lines), with 200 of 448 (44.6%) improving by 0.30 logMAR or more (?3 Snellen lines) and 32 of 448 (7.1%) worsening by 0.30 logMAR or more. Reference eyes gained a mean (SD) of 0.44 (0.26) logMAR (approximately?4 Snellen lines), with 48?583 of 77?408 (62.8%) improving by 0.30 logMAR or more and 2125 of 77?408 (2.7%) worsening by 0.30 logMAR or more. Although all eyes with preoperative VA of 20/40 or less improved, only reference eyes with preoperative VA of more than 20/40 showed improvement. Cystoid macular edema developed in 57 of 663 ERM eyes (8.6%) (95% CI, 6.69-10.98) and 1731 of 125?435 reference eyes (1.38%) (95% CI, 1.32-1.45) (P?<?.001). Epiretinal membrane surgery was performed in 43 of 663 (6.5%) ERM eyes. Conclusions and Relevance:On average, VA improved 0.27 logMAR (approximately 3 Snellen lines) in eyes with ERM. Eyes with ERM and VA of 20/40 or less showed more benefit after cataract surgery than those with better preoperative vision. However, compared with eyes without ERM, higher rates of cystoid macular edema and a lower postoperative VA gain were noted.

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Refractive outcomes of cataract surgery in primary congenital glaucoma.

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Refractive outcomes of cataract surgery in primary congenital glaucoma.

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