| ObjectiveTo investigate the relevant factors that affecting the recovery of visual reconstruction aftercongenital cataract surgery.Methods1. The records collected of children who were diagnosed congenital cataract andunderwent cataract extraction between January1994and January2011wereretrospectively reviewed.2. Grouping:(1) According to the eyes involved: bilateral cataract, unilateral cataract.(2) According to the best corrected visual acuity(BCVA): BCVA>0.3, BCVA≤0.3.(3) According to the cataract type: dense type(including total type, dense nuclearal type,etc.), undense type(including punctate type, lamellar type, sutural type, anterior polartype, posterior polar type, etc.).(4) According to the age undertaking surgery: Baby group(age<1year), infant group(1year≤age <3year), preschool group(3year≤age <7year), school children(7year≤age <14year).3. Age at surgery, cataract type, surgical approach, complications, postoperativebest-corrected visual acuity, binocular fuction and compliance with amblyopia treatmentwere evaluated.4. Analyze the effects of the above factors in visual acuity and visual function, basing onthe three level of visual acuity, binocular vision and fusion function, stereopsis function.5. Statistical analysis: SPSS18.0(IMB Corporation, Armonk, NY) was used to performthe calculations. Statistical comparisons were performed with the use of theχ2test.P<0.05was considered statistically significant.Results1. Visual acuityThere are369patients of519that could cope with the visual acuity examination, aging3month to14years, averaged6.37±3.77year, including226bilateral cataract and143unilateral cataract.(1) There are57.1%patients’ BCVA>0.3in bilateral cataract, while25.2%in unilateralpatients. Bilateral patients have better recovery in visual acuity than unilateralpatients(χ2=50.303，P=0.000).(2) Undense type cataract patients have better recovery in visual acuity than dense typecataract patients(bilateral cataract:χ2=44.159，P=0.000; unilateral cataract:χ2=5.220，P=0.022)(3) It’s positively correlated between surgery age and BCVA in bilateral cataract schoolchildren(r=0.175,P=0.031). It’s negatively correlated between surgery age and BCVA inunilateral cataract school children(r=-0.258,P=0.040). In other age groups, the correlationis not significant(P>0.05). (4) Bilateral patients who underwent primary Intraocular Lens(IOL) implantation havebetter recovery in visual acuity than those who underwent secondary IOL implantion(χ2=55.491，P=0.000). While it’s not significant in unilateral patients.(5) It’s negatively correlated between compliance with amblyopia treatment andBCVA(r=-0.330,P=0.000). This maybe happened because patients with low visual acuitytend to cope with amblyopia treatment better. But low compliance with amblyopiatreatment may lead to anisometropic amblyopia. It’s positively correlated betweencompliance with amblyopia treatment and BCVA(r=0.387,P=0.000).(6) There are146patients(218eyes) who can cope with the visual acuity before surgery.Comparing with the visual acuity before surgery,188eyes got improved visualacuity(86.2%).2eyes got decreased visual acuity(0.9%, anisometropic amblyopia led bylow compliance with amblyopia treatment).28eyes got the same visual acuity(12.8%).The visual acuity was improved0.254±0.246among all of the146eyes.2. Simultaneous perception and fusion functionBy the end of the last follow-up, there are69patients who can cope with the binocularfunction examination. There are64patients who have simultaneous perception and fusionfunction, including36bilateral patients(56.25%) and28unilateral patients(43.75%).There are18patients whose simultaneous perception and fusion function are normal.These18patients are all bilateral patients.(1) There are no significant difference in recovery of simultaneous perception and fusionfunction between different cataract types.(2) There are no significant difference in recovery of simultaneous perception and fusionfunction between different surgery age.(3). Bilateral patients who underwent primary Intraocular Lens(IOL) implantation have better recovery in simultaneous perception and fusion function than those who underwentsecondary IOL implantion(t=4.426，P=0.000). All the unilateral patients who havesimultaneous perception and fusion function underwent primary Intraocular Lens(IOL)implantation.(4) It’s positively correlated between compliance with amblyopia treatment andsimultaneous perception and fusion function (r=0.523,P=0.004). In the unilateral patients,the correlation is not significant(r=-0.188,P=0.245).3. Stereopsis functionBy the end of the last follow-up, there are69patients who can cope with the binocularfunction examination. There are64patients who have stereopsis function, including36bilateral patients(56.25%) and28unilateral patients(43.75%). There are5patients whosestereopsis function are normal. These5patients are all bilateral patients.(1) Dense type cataract patients have better recovery of stereopsis function than undenseones in unilateral patients(t=-3.805, P=0.000), while it’s not significant in bilateralpatients.(2) The correlation is not significant between recovery of stereopsis function and surgeryage in bilateral cataract patients. It’s positively correlated between recovery of stereopsisfunction and surgery age in unilateral cataract patients (r=-0.782,P=0.000).(3) It’s not significant difference in recovery of stereopsis function between primary andsecondary IOL implantation in bilateral patients. All the unilateral patients who havestereopsis function underwent primary IOL implantation.(4)It’s negatively correlated between compliance with amblyopia treatment and stereopsisfunction (r=-0.549,P=0.001). This maybe happened because patients with low visualacuity tend to cope with amblyopia treatment better. In the unilateral patients, the correlation is not significant(P>0.05).ConclusionThe visual recovery of congenital cataract is correlated with the involved eye and cataracttype. High compliance with amblyopia treatment is good for unilateral cataract patients’BCVA and fusion function. Low compliance with amblyopia treatment may lead toanisometropic amblyopia. Patients who underwent primary IOL implantation have betterrecovery of visual acuity and biocular function than those who underwent secondary IOLimplantation in binocular patients. |
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