| BackgroundAlthough improvements in healthcare systems around the world,congenital cataracts still remain among one of the most important causes for preventable blindness in children.It is believed that there are over 200,0000 children blind because of cataract all over the world,of which more than half live in Asia.The occurrence of congenital cataract in developing countries is reported as high as1-15/10000 children.In addition,blindness because of congenital cataract bring an enormous problem to developing countries in terms of human morbidity,economic and social burden.Treatment and recovery the sight of one child from cataract may be equivalent to restoring the sight of 10 elderly adults.In fact,control of childhood blindness has been identified as a priority of the World Health Organization’s global initiative for the control of avoidable blindness by the year 2020.At present,management of congenital cataracts poses several challenges,right form diagnosis to timely surgical treament,intraoperative challenges and postoperative management including visual rehabilitation.Often,despite a successful anatomical of cataract surgery,functional outcomes remain poor.Early correction of aphakic refractive error is the most critical part in management of such cases to prevent the development of amblyopia.With the development of science and technology and the improvement of medical treatment,there is a tend ency of premature surgery in children with congenital cataract in recent years.However,children ’s eyes are still in the developmental stage.Therefore to choose the appropriate intraocular lens as far as minimize the postoperative refractive error is that we need to pay close attention.To select the approriate intraocular lens degree for the children,we need to know the development law of the eye after surgery,mainly including the axial length,corneal curvature and diopter.Children with congenital cataract surgery way mainly divided into two kinds,for more than 2 years old who usually adopt congenital cataract extraction,posterior continuous curvilinear capsulorhexis,anterior vitrectomy and primary IOL implantation in the capsular bag.for children younger than age 2 is implanted intraocular lens is bigger controversy,but there is still a lot of controversy about the implantation of intraocular lenses for children less than two years of age.Postoperative children usually have the condition of intraocular lens and unmanned lens.Regardless of which condition,the rule of normal eyeball development is broken.Therefore,studying the postoperative development rule of children with congenital cataract is very helpful for the treatment of children.Previous studies on the development of postoperative eyeball in children with congenital cataract have been done more.However,the results are not completely consistent.The aim of this study is to investigate the development of ocular axis,changes of corneal curvature and diopter in children after 3～6 years old after congenital cataract surgery,which will provide more help for children’s treatment.PurposeThe changes of axial length,corneal curvature and diopter in children after congenital cataract surgery between 3 and 6 years old,compared with normal children of the same age.To further understand the rule and influencing factors of postoperative eyeball development,and provide theoretical basis for the selection of surgical methods,the selection of intraocular lens and postoperative refractive diopter in clinical practice.It can reduce the error of postoperative refractive index to achieve better postoperative effect,improve visual quality and reduce the number of surgery.ObjectsCongenital cataract extraction was performed in our hospital about 3 months after birth from January 2011 to January 2012,periodic reexamination,diopter correction and amblyopia training.About 2 years old to our hospital for two phase IOL implantation,the follow-up time is about 6 years.Admission criteria for cases:Children with congenital cataract with single eyes or eyes.The operative procedures included for about 3 months in phacoemulsification,posterior capsulotomy,and anterior vitreous body resection,underwent two intraocular lens implantation about2 years old.There were no serious complications after operation,such as secondary glaucoma,posterior obstacle,uveitis and so on.The preoperative examination data such as the length of the ocular axis,the curvature of the cornea,the results of optometry,the degree of implantation of IOL and the retention of the diopter,the history of the disease and the family history were more complete.It can be rechecked regularly and the compliance is better.Before the operation,the related examination was perfected,the other diseases of the whole body were eliminated and the healthy people were in good condition.Ocular diseases such as congenital glaucoma,uveitis,congenital corneal disease,retina and optic nerve diseases and ocular trauma were eliminated.The major complications were secondary glaucoma,posterior cataract,IOL displacement,net removal,uveitis and so on.The whole body suffers from the temperament of the disease.Children and family members are poor compliance,can not be rechecked regularly,and can not adhere to the amblyopia trainer.Incomplete data of preoperative examination and incomplete postoperatively.During the follow-up 2 cases had secondary glaucoma,1 cases had concurrent cataract,1 cases had IOL eccentricity and 3 cases were lost,all of them had been excluded.There were 61 cases(107 eyes),including 46 cases(92 eyes),15 cases(15eyes),15 cases(15 eyes),31 cases(55 eyes),30 cases(52 eyes).The age of the follow-up was divided into 4 groups: group A: 3 years of age;group B: 4 years of age;group C: 5 years;group D: 6 years.Methods61 cases(107 eyes)were extirped in our hospital for congenital cataract about 3months after birth,and the two stage intraocular lens implantation was performed in our hospital at about 2 years of age.The follow-up was about 6 years.The axial length of the eyes,the curvature of the cornea,the diopter and the best corrected visual acuity were measured at the age of 3,4,5,and 6.According to the age of measurement,the 4 groups were divided into 4 groups: 3 years old(group A),4years old(group B),5 years old(group C),6 years old(group D).Another 3～6 year old children matched with the age and sex of the study group.A cross-sectional case control study was used to compare the differences between the two groups.All data of this study were statistically analyzed using SPSS 21 statistical software.The data obtained from the experiment are expressed by mean standard deviation,Kolmogorov-Smirnov test method is used to test whether the variables of the measurement data conform to the normal distribution.If the normal distribution is conformed to the normal distribution,the two independent sample t test is used.The rank sum test is used if the normal distribution is not in accordance with the normal distribution.The single factor analysis of variance was used in the same group.The difference of P<0.05 was statistically significant.Results1.After congenital cataract surgery patients were 3 and 4 years old,5 years old,6 years old when the axial length measurements were 22.28 ± 1.09 mm,23.02 ±0.84 mm,23.62 ± 0.73 mm,23.94 ± 0.75 mm,the control group of normal children age axis measurement were 21.59 ± 0.58 mm,22.15 ± 0.68 mm,22.69 ± 0.37mm22.93 ± 0.46 mm,experimental group and control group with normal children compared with long axial length,the differences were statistically significant(P=0.007,0,0,0).2.The axial length of the eye in patients with unilateral congenital cataract 3years old group,4 years old group,5 years old group measurements were 21.57 ±1.68 mm,22.96 ± 1.90 mm,23.02 ± 0.40 mm,the axial length of the normal eyes were21.46 ± 0.63 mm,22.46 ± 1.25 mm,22.62 ± 0.34 mm,the differences were not statistically significant in each age group(P=0.909,0.724,0.125);6 patients eyes and normal eyes eye long axis were 23.42 ± 0.13 MM,22.93 ± 0.16 mm,the difference was statistically significant(P=0.003).3.The experimental group after congenital cataract surgery among children in each age group compared to the axial length,the 3 year old group and 4 year old group,3 year old group and 5 year old group,3 year old group and 6 year old group,4 year old group and 5 year old group,4 year old group and 6 year old group compared were statistically significant(P=0.000,0,0,0.002,0),5 years old group 6years old group had no significant difference(P=0.059).4.The curvature of the cornea in experimental group after congenital cataract surgery in children with 3 years old group,4 years old group,5 years old group,6years old group were 43.98 ± 1.87 D,43.80 ± 1.53 D,42.84 ± 1.59 D,43.38 ± 1.72 D,controls the corneal curvature of normal children were 42.87 ± 1.25 D,43.29 ± 1.37 D,43.34 ± 1.32 D,43.30 ± 1.38 D.There was a statistically significant difference in corneal curvature between 3 years old group and normal children in the same age group(P=0.005),but there was no significant difference between the 4 year old group,5 year old group and 6 year old group(P=0.098,0.197,0.795).5.The corneal curvature of children aged 3 years,4 years,5 years,and 6 years after unilateral congenital cataract surgery respectively was 44.08 ± 2.41 D,43.95 ±0.25 D,43.47 ± 1.45 D,43.01 ± 1.06 D,the corneal curvature of each age group was43.86 ± 2.09 D,43.48 ± 0.01 D,43.43 ± 1.29 D and 43.03 ± 1.27 D respectively,and there was no significant difference between the operation eyes and the healthy eye group(P=0.892,0.856,0.966,0.981).6.The corneal curvature was compared between the age groups of the children with congenital cataract in the experimental group,3 years old group and 4 years old group,3 years old and 6 years old group,4 years old and 5 years old group,4 years old group and 6 years old group,5 years old group and 6 years old group,the differences were not statistically significant(P=0.633,0.118,0.059,0.296,0.278).However the difference between the 3 year old group and the 5 year group was statistically significant(P=0.021).7.The experimental group after congenital cataract surgery in children with 3years old group 4 years old group 5 years old group 6 years old group of diopter was2.55 ± 1.44 D,1.07 ± 2.20 D,-0.82 ± 0.93 D and-0.83 ± 1.55 D respectively,control group of normal children diopter were 1.79 ± 1.21 D,1.40 ± 1.15 D,1.19 ± 1.20 D,1± 0.97 D.There was no significant difference in corneal curvature between 4 year old children with congenital cataract and normal children(P=0.369).The difference between 3 year old group,5 year old group and 6 year old group was statistically significant(P=0.030,0,0).8.The experimental group after congenital cataract surgery among children in each age group diopter compared among the 3 years old group and 4 years old group,3 years old group and 5 years old group,3 years old group and 6 years old group,4years old group and 5 years old group,4 years old group and 6 years group were statistically significant compared(P=0.001,0,0,0,0),5 years old group and 6 years old group had no significant difference(P=0.984).9.The best corrected visual acuity(BCVA)was compared with the 6 year old group at the last follow-up of children with congenital cataract.The best corrected visual acuity(BCVA)less than 0.1 have 7 eyes and the percentage was 6.5%,0.1 and0.3 have 11 eyes and the percentage was 10.3%,0.3 and 0.5 have 28 eyes and the percentage was 26.2%,0.5 and 0.7 have 35 eyes and the percentage was 32.7%,more than 0.7 have 26 eyes and the percentage was 24.3%.10.The best corrected visual acuity of binocular children and monocular children at the last follow-up was 0.52 ± 0.23 and 0.36 ± 0.27 respectively.The best corrected visual acuity of binocular children was better than that of monocular children at the last follow-up.There was a significant difference between the two groups(P=0.023).Conclusion1.Cataract extraction is performed at 3 months or so in children with congenital cataract and at 2 years of age,phase II IOL implantation is the best time to treat congenital cataract,and it can effectively prevent the occurrence of amblyopia.2.The eye axis length of the children in the experimental group is longer than that of the normal children,which can form a larger myopia drift.The growth of the eye axis is the main reason for the formation of myopia drift.3.The corneal curvature of the children in the experimental group was in accordance with the normal development of children,and the development of corneal curvature after 3 years of age basically tended to adult level.4.The postoperative eyes of children with monocular congenital cataract which can maintain a consistent growth with the contralateral eye.5.The recovery of visual acuity in children with congenital cataract is better than that of children with single eye.6.After 3～6 years of age,the degree of refraction of children with congenital cataract is mainly in the direction of myopia.The amplitude of myopia drift is larger than that of normal children of the same age.The drift amplitude of myopia decreases with age. |
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