J Korean Ophthalmol Soc.  2011 Mar;52(3):325-331. 10.3341/jkos.2011.52.3.325.

Factors Associated with Strabismus after Cataract Extraction and Primary Intraocular Lense Implantation in Congenital Cataracts

• Kim SH
• Kim WS
• Lee SJ

• KMID: 2214297
• DOI: http://doi.org/10.3341/jkos.2011.52.3.325

Abstract

PURPOSE
To evaluate factors associated with the development of strabismus after cataract extraction and primary intraocular lens implantation.
METHODS
Medical records of 80 patients who had undergone cataract extraction with primary intraocular lens implantation between 6 months and 21 years of age from March 1993 to March 2008 were reviewed. Nine patients (11 eyes) with strabismus before cataract surgery were excluded. Patients were divided into 2 groups; patients with congenital bilateral cataracts (43 patients, 86 eyes) or patients with unilateral cataracts (28 patients, 28 eyes). Data were collected on age at cataract surgery, pre and post-cataract extraction visual acuity, interocular visual acuity differences, nystagmus, operation method, and the existence of associated other ocular diseases to evaluate the association of the onset of strabismus and after cataract.
RESULTS
Factors statistically significantly associated with the development of strabismus include presence of nystagmus in bilateral cataracts and postoperative visual acuity differences > 0.3 in unilateral cataracts. A post-cataract extraction mean visual acuity < or = 0.2 and preservation of posterior capsule were significant factors in both groups.
CONCLUSIONS
Children with congenital cataracts should be monitored carefully after cataract surgery for the development of strabismus especially when they have poor postoperative visual acuity, nystagmus, large postoperative interocular visual acuity differences, or preservation of posterior capsule.

Keyword

Congenital cataract; Nystagmus; Posterior capsule; Strabismus; Visual acuity

MeSH Terms

Cataract
Cataract Extraction
Child
Humans
Lens Implantation, Intraocular
Lenses, Intraocular
Medical Records
Strabismus
Visual Acuity

Reference

References

1. Thylefors B. A global initiative for the elimination of avoidable blindness. Am J Ophthalmol. 1998; 125:90–3.

2. Rahi JS, Dezateux C. Congenital and infantile cataract in the United Kingdom: underlying or associated factors. British Congenital Cataract Interest Group. Invest Ophthalmol Vis Sci. 2000; 41:2108–14.

3. Steinert RF. Cataract surgery: Technique, complications, and management. 2nd ed.Philadelphia: WB Saunders;2004. p. 273.

4. Ledoux DM, Trivedi RH, Wilson ME Jr, Payne JF. Pediatric cataract extraction with intraocular lens implantation: visual acuity outcome when measured at age four years and older. J AAPOS. 2007; 11:218–24.

5. Birch EE, Cheng C, Stager DR Jr, et al. The critical period for surgical treatment of dense congenital bilateral cataracts. J AAPOS. 2009; 13:67–71.

6. Weisberg OL, Sprunger DT, Plager DA, et al. Strabismus in pediatric pseudophakia. Ophthalmology. 2005; 112:1625–8.

7. Oh MJ, Min WK, Min BM. The association of strabismus and congenital cataract. J Korean Ophthalmol Soc. 1989; 30:611–5.

8. Robb RM, Petersen RA. Outcome of treatment for bilateral congenital cataracts. Ophthalmic Surg. 1992; 23:650–6.

9. Zetterström C, Lundvall A, Kugelberg M. Cataracts in children. J Cataract Refract Surg. 2005; 31:824–40.

10. Greenwald MJ, Glaser SR. Visual outcomes after surgery for unilateral cataract in children more than two years old: posterior chamber intraocular lens implantation versus contact lens correction of aphakia. J AAPOS. 1998; 2:168–76.

11. Apple DJ, Ram J, Foster A, et al. Pediatric Cataract. Surv Ophthalmol. 2000; 45:S150–68.

12. Kornder LD, Nursey JN, Pratt-Johnson JA, Beattie A. Detection of manifest strabismus in young children. 2. A retrospective study. Am J Ophthalmol. 1974; 77:211–4.

13. Preslan MW, Novak A. Baltimore Vision Screening Project. Phase 2. Ophthalmology. 1998; 105:150–3.

14. Friedman Z, Neumann E, Hyams SW, Peleg B. Ophthalmic screening of 38,000 children, age 1 to 2 1/2 years, in child welfare clinics. J Pediatr Ophthalmol Strabismus. 1980; 17:261–7.

15. Lambert SR, Lynn M, Drews-Botsch C, et al. A comparison of gra-ting visual acuity, strabismus, and reoperation outcomes among children with aphakia and pseudophakia after unilateral cataract surgery during the first six months of life. J AAPOS. 2001; 5:70–5.

16. Kohansby D, Gurwood AS. Pediatric cataracts. Clin Eye Vis Care. 1997; 9:85–93.

17. Lundvall A, Kugelberg U. Outcome after treatment of congenital bilateral cataract. Acta Ophthalmol Scand. 2002; 80:593–7.

18. Sidikaro Y, von Noorden GK. Observations in sensory heterotropia. J Pediatr Ophthalmol Strabismus. 1982; 19:12–9.

19. Lambert SR. Treatment of congenital cataract. Br J Ophthalmol. 2004; 88:854–5.