Surgical Outcomes Of Congenital Cataract Surgery In Children With Premature Or Low Weight

Objective: To evaluate the surgical outcomes of congenital cataract surgery with premature delivery or low weight.Methods: Data of 14 children(24 eyes)who underwent congenital cataract surgery in the ophthalmology department of the First Affiliated Hospital of Guangxi Medical University from September 2014 to June 2019 were collected.Their gestational age at birth was less than 37 weeks or their birth weight was less than 2.5 kg.Their first surgical correction was less than 24 months of age and their follow-up time was ≥6 months.Age of premature infants was assessed by corrected month age.Low-weight infants were treated surgically when their weight reached the level of infants of the same age.The observation indexes included the morphology of cataract,actual age at operation,corrected age at operation,weight at operation,intraoperative complications,IOL implantation,adverse events including visual axis opacities(VAO),pupil deformation,iris adhesion,glaucoma and fundus condition,best corrected distance visual acuity(BCDVA),spherical equivalent(SE),anisometropia in the last follow-up.SE =spherical degree + 1/2 cylindrical degree.Anisometria is defined as SE difference(≥1.0D)in both eyes,where ≥1.0D and <2.5D are mild anisometropia,and ≥2.5D are highly anisometropic.SPSS25.0 software was used for statistical analysis.Results:1.Basic information of children: in this study,14 cases(24 eyes)were included,including 7 cases(12 eyes)of premature delivery with low body weight,2 cases(3 eyes)of premature delivery with normal body weight,and 5cases(9 eyes)of full-term delivery with low body weight.The ratio of male to female was 1:1.In this study,the average gestational age wasthirty-four point34.73±3.44w(scope:27.00-39.00w),average birth weight istwo point2.13±0.41kg(scope:1.10-2.60kg).Data regarding the morphology of cataract were available in 24 eyes,of which 15 eyes(62.50%)had total cataract,9 eyes(37.50%)each had nuclear cataract.14 cases of preterm low birth weight infants did not show retinal detachment in B-ultrasonic examination before operation.2.Operation condition: at the first operation,the average corrected age iseleven point11.17±6.73m(scope:3.5-23.5m),the average operating weight isseven point7.35±1.58kg(scope:5.00-11.00kg).The surgical methods were:(1)single-eye/double-eye cataract extraction + posterior capsulotomy + anterior vitrectomy + stage I IOL implantation;(2)single-eye/double-eye cataract extraction + posterior capsulotomy + anterior vitrectomy,followed by or without stage II IOL implantation.12 cases(20 eyes)were implanted with IOL,among which 9 cases(14 eyes)were implanted in the first stage and 3 cases(6 eyes)were implanted in the second stage.Among them,1 case was younger in the last follow-up,and 1 case had microcornea.Intraoperative mydriasis was observed in 4 eyes(16.7%).No serious complications such as rupture of capsule and choroidal hemorrhage occurred during the operation.3.Surgical complications(1)Short term complications: the common short-term postoperative complications were transient corneal edema in 8 eyes(33.3%)The second is the exudation of iris / pupil area,5 eyes in total(20.8%).All disappeared within 7days after operation.(2)Adverse events: pupil deformation was observed in 6 eyes(25.0%)with long-term adverse events 4 eyes with turbid optic axis(16.7%);iris synechia 1eye(4.2%).Intraocular pressure was obtained in 16 eyes at the last follow-up,and the mean intraocular pressure was 16.26 ± 3.00 mm Hg(range:10.10 ～20.55 mm Hg).4.Postoperative refraction:The median follow-up time was 1.83 y(1.00-2.68 y),and the median age at the last follow-up was 2.39 years(1.49-4.16 years).At the last follow-up,there were 8 eyes,6 eyes,4 eyes,4 eyes and 2 eyes in the age groups of 1 year,2years,3 years,4 years and 5 years,respectively.(1)Median SE in the last follow-up: in the eyes implanted with IOL and obtained SE in the last follow-up,the children aged 1,2,3,4 and 5 years old at the last follow-up had 4 eyes,4 eyes,4 eyes and 2 eyes respectively.The median SE was +2.50D(-1.88 ～ +7.25D).In the eyes without IOL implantation,SE of 1case and 2 eyes at the last follow-up was+14.50 DIn the other case,2 eyes were right eyes+11.73 D,left eye+12.22 D.(2)Total refractive status distribution: of the eyes implanted with IOL and obtained se at the last follow-up,13 eyes showed good refractive status at the last follow-up.There were 2 eyes in light myopia(-3.0D ≤ SE <-0.5D),4 eyes in emmetropia(-0.5D ≤ SE < +0.5D),7 eyes in light hyperopia(+0.5D < SE < +3D),2 eyes in moderate hyperopia(+3D < SE ≤ +5D),3 eyes in high hyperopia(SE > +5D).(3)Anisometropia: a total of 13 cases obtained the follow-up results of anisometropia,9 cases were in good condition,there were 8 cases(61.53%)without anisometropia(<1.0D),1 case(7.70%)with mild anisometropia(≥1.0D and <2.5D)and 4 cases(30.77%)with high anisometropia(≥2.5D).(4)Best corrected distance visual acuity: Because the patient was too young to cooperate,only 4 cases and 8 eyes obtained BCDVA test results.The BCDVA of them were 0.6,0.4,0.05,0.3,0.6,0.5,0.4,0.5(international standard vision chart),respectively.Conclusions: Congenital cataract surgery is performed when the premature infant reaches the corrected age and when the low-weight infant reaches the same age level,which could obtain good clinical results.