Strabismus surgery outcomes in the Infant Aphakia Treatment Study (IATS) at age 5 years

Strabismus and Nystagmus in Patients With Pediatric Cataracts: Study Using Insurance Claims Data

PURPOSE

To describe the characteristics and prevalence of strabismus and nystagmus in children diagnosed with cataracts using a national insurance claims database.

DESIGN

Population-based retrospective cohort study.

METHODS

Patients aged <13 years diagnosed with cataracts (traumatic cataracts excluded) and enrolled continuously in their health care program for ≥5 years after their first cataract diagnosis were identified in a retrospective review of 66 million charts in Optum's de-identified Clinformatics Data Mart Database between 2003 and 2015. Patients were categorized based on age of their first diagnosed cataract, and if cataract surgery was performed. Clinical and demographic factors associated with the occurrence of strabismus and nystagmus were evaluated.

RESULTS

Of 1636 children diagnosed with cataract, 434 (26.5%) and 109 (6.7%) were diagnosed with strabismus and nystagmus, respectively. Both strabismus and nystagmus were more common in those who underwent cataract surgery (P < .001) and in patients diagnosed with cataract at ≤12 months of age (P < .001). Survival analysis demonstrated that strabismus and nystagmus may be diagnosed 8 years after the initial cataract diagnosis. Cox proportional hazard regression analyses revealed strabismus was associated with cataract surgery, nystagmus, and the diagnosis with cataract at ≤12 months and cataract surgery at >12 months.

CONCLUSIONS

As strabismus and nystagmus occur more frequently in children diagnosed with cataracts necessitating cataract surgery, regular long-term follow-up is crucial for these children to monitor for the development of strabismus and nystagmus.

Risk Ractors for Strabismus Surgery after Pediatric Cataract Surgery in the United States

Purpose

To determine the cumulative incidence of strabismus surgery after pediatric cataract surgery and identify the associated risk factors.

Design

US population-based insurance claims retrospective cohort study.

Participants

Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics Data Mart (2003-2021) and IBM MarketScan (2007-2016).

Methods

Individuals with at least 6 months of prior enrollment were included, and those with a history of strabismus surgery were excluded. The primary outcome was strabismus surgery within 5 years of cataract surgery. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), intraocular lens (IOL) placement, nystagmus and strabismus diagnoses before cataract surgery, and cataract surgery laterality.

Main Outcome Measures

Kaplan-Meier estimated cumulative incidence of strabismus surgery 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models.

Results

Strabismus surgery was performed on 271/5822 children included in this study. The cumulative incidence of strabismus surgery within 5 years after cataract surgery was 9.6% (95% CI, 8.3%-10.9%). Children who underwent strabismus surgery were more likely to be of younger age at the time of cataract surgery, of female sex, have a history of PFV or nystagmus, have a pre-existing strabismus diagnosis, and less likely to have an IOL placed (all P < 0.001). Factors associated with strabismus surgery in the multivariable analysis included age 1 to 4 years (HR, 0.50; 95% CI, 0.36-0.69; P < 0.001) and age > 5 years (HR, 0.13; 95% CI, 0.09-0.18; P < 0.001) compared with age < 1 year at time of cataract surgery, male sex (HR, 0.75; 95% CI, 0.59-0.95; P < 0.001), IOL placement (HR, 0.71; 95% CI, 0.54-0.94; P = 0.016), and strabismus diagnosis before cataract surgery (HR, 4.13; 95% CI, 3.17-5.38; P < 0.001). Among patients with strabismus diagnosis before cataract surgery, younger age at cataract surgery was the only factor associated with increased risk of strabismus surgery.

Conclusions

Approximately 10% of patients will undergo strabismus surgery within 5 years after pediatric cataract surgery. Children of younger age, female sex, and with a pre-existing strabismus diagnosis undergoing cataract surgery without IOL placement are at greater risk.

Financial Disclosures

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

North India Childhood Cataract Study - The real scenario and causes of surgical delay of pediatric cataract

Purpose:

The study sought to describe the clinical presentation pattern of pediatric cataracts and factors leading to delay in surgery at a tertiary care center in North India.

Methods:

A cross-sectional, interview-based study was conducted from January 2020 to October 2020, that included pediatric patients <12 years, with unilateral or bilateral congenital or developmental cataract. A pre-validated questionnaire was used to record data. The parameters recorded were age at first symptoms, age at diagnosis of cataract, age at surgery, laterality of cataract, first symptom, first family member noticing the abnormality, the morphology of cataract, association of perinatal complications, family history, systemic diseases, and cause (s) of delay in surgery.

Results:

A total of 89 patients were included. The mean age of subjects was 4.75(±3.51) years. A white pupil was the most common symptom (64.04%) and appeared in infancy in 30.3% of cases. Parents first detected the problem in 60.67%, and the pediatrician was the first medical contact in 11.23% of cases. The median (IQR) delay period between diagnosis of cataract and cataract surgery was 4 (3–6) months, the major causes were long GA waiting (30.33%), and delay due to systemic ill health (14.61%).

Conclusion:

Parental education on cataract detection is recommended to help in the timely detection and hence, improved outcomes of pediatric cataract surgery. Pediatricians, consulted for any systemic illness, have the role of the second most important contact in the detection of pediatric cataract.

Preoperative Predictors for Esodeviation and Exodeviation after Cataract Surgery in Children

Purpose: For those children that went on to have strabismus surgery after cataract surgery, we sought to identify preoperative predictors for whether strabismus surgery would be for an esodeviation or for an exodeviation.Design: Retrospective studyMethods: Charts of patients <18 years who underwent cataract surgery were reviewed. Data from the first strabismus surgery after cataract surgery were reviewed. Statistical analysis was performed using T-test for continuous variable and chi-square test for categorical variable. A binomial logistic regression was performed to ascertain the effects of variables that were found to be significant.Results: 142 patients were identified having strabismus surgery. Type of deviation at first strabismus surgery was: Esodeviation: 72 (50.7%), exodeviation 55 (38.7%), and surgery for only vertical strabismus 15 (10.6%). Age at cataract surgery was an independent variable determining subsequent surgery for esodeviation or exodeviation. For each year increase in age at cataract surgery, the odds of having surgery for exotropia instead of esotropia increases by a factor of 1.620 (P = .005). Odds that strabismus surgery will be for exodeviation is 4.9 times higher in children who had cataract surgery at 1 year of age or greater as compared to children <1 year of age (P < .001).Conclusion: For those children who went on to have strabismus surgery after cataract surgery, younger age at cataract surgery increases the chance that subsequent strabismus surgery will be for an esodeviation. Those who had cataract surgery at an older age were more likely to have surgery for exotropia than for esotropia.

Oculocerebrorenal syndrome of Lowe: Survey of ophthalmic presentations and management

BACKGROUND

Lowe syndrome is a rare X-linked disease that is characterized by renal dysfunction, developmental delays, congenital cataracts and glaucoma. Mutations in the oculocerebral renal syndrome of Lowe (OCRL) gene are found in Lowe syndrome patients. Although loss of vision is a major concern for families and physicians who take care of Lowe syndrome children, definitive cause of visual loss is still unclear. Children usually present with bilateral dense cataracts at birth and glaucoma, which occurs in more than half of cases, either concurrently or following cataract surgery.

MATERIALS AND METHODS

A retrospective review was conducted on the prevalence and characteristics of ocular findings among families of patients with Lowe syndrome with 137 uniquely affected individuals.

RESULTS

Of 137 patients, all had bilateral congenital cataracts. Nystagmus was reported in 69.3% of cases, glaucoma in 54.7%, strabismus in 35.0%, and corneal scar in 18.2% of patients. Glaucoma was reported as the most common cause of blindness (46%) followed by corneal scars (41%). Glaucoma occurred in 54.7% of patients and affected both eyes in the majority of cases. Of these patients, 55% underwent surgery for glaucoma, while the remaining patients used medications to control their eye pressure. Timolol and latanoprost were the most commonly used medications. Although trabeculectomy and goniotomy are commonly used for pressure management, aqueous tube shunts had the best outcomes.

CONCLUSION

Ocular manifestations in individuals with Lowe syndrome and carriers with OCRL mutation are reported which may help familiarize clinicians with the ocular manifestations and management of a rare and complex syndrome.

Effect of Timing of Initial Cataract Surgery, Compliance to Amblyopia Therapy on Outcomes of Secondary Intraocular Lens Implantation in Chinese Children: A Retrospective Case Series

Purpose

As a secondary analysis, we reassess the association of initial congenital cataract surgery times, compliance to amblyopia therapy, and visual outcomes for a long-term follow-up in a secondary IOL implantation.

Methods

Retrospective review of records of all infants with congenital cataracts who underwent secondary IOL implantation in the Eye and ENT Hospital of Fudan University from January 1, 2001, to December 31, 2007, and the minimum follow-up period was 5 years. Multiple regression analysis was used and the possible confounding factors were also analyzed to assess the effect on visual outcome.

Results

A total of 110 patients (male: 59.1%) were included. The median (min-max) age at cataract extraction and IOL implantation was 7.5 (3.0-15.0) and 35.0 (22.0-184.0) months, respectively, and the average follow-up period was 99.3 ± 23.6 months. The median (min-max) BCVA at final follow-up was 0.20 (0.01-1.00). Compliance to amblyopia therapy was none, poor, and good in 21.8%, 24.5%, and 53.6%, respectively. Postoperative BCVA [logMAR, median (min-max) 0.70 (0.00-2.00)] linearly decreased with increasing cataract extraction time (per month) (β = 0.04, 95% CI: 0.03-0.06, p < 0.0001) in multivariable models with laterality and compliance to amblyopia therapy adjusted. Good compliance to amblyopia therapy was associated with better BCVA (logMAR) at last follow-up (β = -0.40, 95% CI = -0.53 to -0.27, p < 0.0001) with laterality, opacity type, and extraction time adjusted.

Conclusions

For Chinese infants with congenital cataract, an earlier primary congenital cataract surgery at an age of 3 to 15 months is associated with a better visual outcome. Good compliance to amblyopia therapy was also significant to visual outcome.