Strabismusaftercongenitalcataractssurgery 窑ClinicalResearch窑 Factorsassociatedwithstrabismusaftercataract extractionandprimaryintraocularlensimplantationin congenitalcataracts DepartmentofOphthalmology,HaeundaePaikHospital, DOI:10.3980/j.issn.2222-3959.2014.03.25 Busan1435,Korea Correspondence to: SooJungLee. Departmentof LeeSJ,KimWS.Factorsassociatedwithstrabismusaftercataract Ophthalmology, HaeundaePaikHospital,Jwa-dong, extractionandprimaryintraocularlensimplantationincongenital Haeundae-gu,Busan1435,[email protected] cataracts. 2014;7(3):522-527 Received:2013-06-24 Accepted:2013-11-25 INTRODUCTION Abstract ongenitalcataractisaconditionobservedin2.2-3of C 10000newborninfantsandisresponsiblefortheloss AIM: To evaluate factors associated with the · [1-3] ofsightin10%ofchildrenworldwidewhobecomeblind . developmentofstrabismusaftercataractextractionand Unlikecataractsinadults,earlydetection,methodandtime primaryintraocularlensimplantation. ofoperation,timeofintraocularlens(IOL)implantation, ·METHODS:Themedicalrecordsof122patients,aged properIOLpower,andopticaltreatmentforamblyopiaafter 1.5moto9y,whohadundergonecataractextractionwith surgeryareimportantforvisualoutcomesinchildrenwith primaryintraocularlensimplantationbetweenJanuary congenitalcataracts [4].Excessiveinflammatoryreaction, 1993andAugust2011werereviewed.Fourteenpatients secondarycataract,glaucoma,andstrabismuscanoccurafter (17eyes)withstrabismusbeforecataractsurgerywere surgery.Especially,therateofstrabismusassociatedwith excluded. Patients were divided into those with congenitalbilateralcataracts(64patients,128eyes)and congenitalcataracthasbeenreportedto rangefrom [5-8] thosewithunilateralcataracts(44patients,44eyes).The 20.5%-86%beforeandaftercataractsurgery .Strabismus associationsbetweenthedevelopmentofstrabismusand occursmorefrequentlyinpatientswithunilateralthan age at cataract surgery, pre- and post-cataract bilateralcataracts[7,8]. extraction corrected distance visual acuity (CDVA), AstudyofpatientswhounderwentprimaryIOLimplantation interocular CDVA difference, nystagmus, surgical forcongenitalcataractfoundthatcorrecteddistancevisual method,andsecondarycataractwereevaluated. acuity(CDVA)beforeandafteroperation,theformof · RESULTS:Factorssignificantlyassociatedwiththe strabismusandthepresenceorabsenceofamblyopiaafter [7] developmentofstrabismusincludedageatcataract surgerywereassociatedwiththeoccurrenceofstrabismus . surgery ( 1y), preoperative mean CDVA 20/100, Factorsrelatedtotheonsetofpostoperativestrabismusin 臆 臆 presenceofnystagmusinthebilateralcataractgroup aphakicorpseudophakicpatientsaftersurgeryforcongenital andpostoperativeinterocularCDVAdifference 跃20/70in cataractincludedolderageatsurgery,developmentof theunilateralgroup.PostoperativeCDVA 20/100and 臆 secondarycataracts,poorvisualrehabilitationaftersurgery, preservation of posterior capsule, and presence of andunilateralcataract [8].Toourknowledge,however,no secondarycataract weresignificant factors in both studyhasassessedfactorsassociatedwithnewlydeveloped groups. strabismusafterprimaryIOLimplantationexceptthecases · CONCLUSION: Children with congenital cataracts withstrabismuswhichalreadyexistedpreoperatively.We shouldbemonitoredcarefullyaftercataractsurgeryfor thereforeanalyzedthefactorsassociatedwiththeonsetof thedevelopmentofstrabismus,especiallywhenthey strabismusaftercataractremovaland primaryIOL underwent surgery at age 1y, and they have 臆 implantationinpatientswithunilateralandbilateral nystagmus, large postoperative interocular CDVA congenitalcataracts. difference,poorpreoperativeandpostoperativeCDVA, SUBJECTSANDMETHODS preservationoftheposteriorcapsule,orsecondary Thisretrospectiveanalysisincluded189eyesof cataract. Subjects 122patientswhounderwentcataractremovalandprimary ·KEYWORDS: strabismus;congenitalcataract;nystagmus IOLimplantationforcongenitalcataractbyonesurgeonat 522 陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 7熏晕燥援 3熏 Jun.18, 圆园14 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-82210956 耘皂葬蚤造押ijopress岳员远猿援糟燥皂 Table 1 Characteristics of patients with congenital cataracts Bilateral cataract (n=64) Unilateral cataract (n=44) Variables Postop. orthotropia Postop. strabismus Postop. orthotropia Postop. strabismus P P (n=53) (n=11) (n=31) (n=13) M:F 26:27 7:4 20:11 6:7 Mean age at surgery (a) 3.7±2.5 (0.2-9) 2.4±1.7 (0.1-5) 0.074 3.1±2.1 (0.5-6) 1.2±0.6 (0.7-2) 0.119 Follow-up period (a) 4.8±2.5 (2-12) 4.9±2.2 (2.8-8) 0.624 4.1±3.8 (2-16) 4.3±2.0 (2-9) 0.671 T able 2 Associations between age at surgery and postoperative onset of strabismus Bilateral cataract (n=64) Unilateral cataract (n =44) Variables Postop. orthotropia Postop. strabismus Postop. orthotropia Postop. strabismus P P (n =53) (n =11) (n =31) (n =13) Age at surgery (a) ≤1 10 6 (37.5%) 0.013 2 3 (60.0%) 0.113 >1 43 5 (10.4%) 29 10 (25.6%) MaryknollhospitalfromJanuary1993toAugust2011.The fixationoftheIOLperformedaftercataractremoval.In patientswithaccompanyingabnormalityoftheeyeswere patientswithbilateralcataracts,itwasregardedasthe excluded.Angleofdeviationwasmeasuredbeforeandafter presenceofsecondarycataractifoneofthebotheyeshad operation,andallincludedpatientswerefollowed-upforat secondarycataract. least2y.Seventeeneyesof14patients(6eyesof3patients StatisticalAnalysis Allstatisticalanalyseswereperformed withbilateralcataractsand11eyesof11patientswith usingSPSSversion12.0.Pearson'sChi-squaretestwas unilateralcataracts)whohadstrabismusbeforesurgerywere employedtocomparediscretevariablesbetweengroups.A excluded.Theremaining108patientsweredividedinto2 two-sample testwasemployedtocomparecontinuous groups:128eyesof64patientswithbilateralcataractsand variablessuchasageatsurgerybetweenthetwogroups.A 44eyesof44patientswithunilateralcataracts,witheach -valuelessthan0.05wasconsideredsignificant.Ethical groupfurthersubdividedintothosewithpreoperative approvalwasobtainedbytheInstitutionalReviewBoardof orthotropiaandpostoperativestrabismusandthosewithpre- MaryknollHospital,andthestudyconductedadheredtothe andpost-operativeorthotropia.Diagnosticcriteriafor DeclarationofHelsinki. congenitalcataractincludedpatientswithcataractobserved RESULTS within1yafterbirth,patientswithafamilyhistoryof Wefoundthat11(17.2%)of64patientswithbilateral congenitalcataract,andpatientswithsystemicdiseaseor cataractsand13(29.5%)of44patientswithunilateral cataractshapesuspectedofbeingcongenital( anterior cataractshadpostoperativeonsetofstrabismus( =0.100) polar,nuclear,lamellar,andsuturalcataract)[9-12]. (Tables1,2). Methods Factorsassessedfortheircorrelationwith PreoperativeCDVAwasdefinedasthemeanCDVAofboth postoperativeonsetofstrabismusincludedageatcataract eyesinpatientswithbilateralcataracts.Patientsinwhom surgery,CDVAbeforeandaftersurgery,interocularCDVA CDVAcouldbemeasuredonlybyCSMorinwhom differencebeforeandaftersurgery,nystagmusbeforeand measurementwasimpossiblewereexcludedfromevaluation aftersurgery,surgicalmethods,andsecondarycataract. of theassociation betweenpreoperativeCDVAand CDVAwasmeasuredwithaSnellenchart,or,with postoperativestrabismus.CDVAwasmeasuredin45 evaluationofcentral,steady,andmaintained (CSM)visual patientswithbilateralcataractsand23withunilateral behaviorinnon-verbalchildren.Surgicalmethodwas cataracts(Tables3,4). dichotomizedbypreservationoftheposteriorcapsule(PC; PostoperativeCDVAatlastfollow-upinpatientswith yes no).Inpatientswithbilateralcataracts,PCremoval bilateralcataractswasmeasuredastheaverageforbotheyes wasdefinedasremovalfrombotheyes.Patientswith in63patients(Table5).Whentheassociationbetween bilateralcataractswhohadunilateralPCremovalwere strabismusandpostoperativeinterocularCDVAdifferenceat regardedasthegroupofintactPC.Ofthe172eyes,131 lastfollow-upwasassessedinpatientswithbilateral underwentposteriorcontinuouscurvilinearcapsulorhexis cataracts(Table6). (PCCC),with107undergoingopticcaptureoftheIOLand Noneofthepatientswithunilateralcataractshadnystagmus 24eyesundergoingIOLimplantationinthebagafter beforeoraftersurgery.Onepatientwithbilateralcataracts anteriorvitrectomyusingavitreouscutter.Ofthe41eyes showedthedisappearanceofnystagmusaftersurgeryand notundergoingPCCC,16hadlensdecentration,withscleral onenewlydevelopednystagmusaftersurgery(Table7). 523 Strabismusaftercongenitalcataractssurgery Table 3 Associations between preoperative visual acuity and postoperative onset of strabismus Bilateral cataract (n =64) Unilateral cataract (n =44) Variables Postop. orthotropia Postop. strabismus Postop. orthotropia Postop. strabismus P P (n=53) (n =11) (n=31) (n =13) -20/100 13 4 11 4 20/80-20/40 19 1 7 1 20/32-20/25 8 0 0 0 ≤20/100 13 4 (23.5%) 11 4 (26.7%) 0.039 0.433 >20/100 27 1 (3.6%) 7 1 (12.5%) CSM (-) 2 3 12 7 CSM (+) 6 1 1 1 CSM(-), CSM (+) 5 2 CSM: Central, steady, maintained. Table 4 Associations between preoperative visual acuity difference between eyes and postoperative onset of strabismus Bilateral cataract (n=64) Unilateral cataract (n=44) Variables Postop. orthotropia Postop. strabismus Postop. orthotropia Postop. strabismus P P (n=53) (n=11) (n=31) (n=13) -20/70 36 4 5 1 20/63-20/40 3 1 5 4 20/32-20/25 1 0 3 1 20/20- 0 0 4 0 ≤20/70 36 4 (10.0%) 5 1 (16.7%) 0.461 0.541 >20/70 4 1 (20.0%) 12 5 (29.4%) Unable to measure 13 6 14 7 Table 5 Associations between postoperative visual acuity and postoperative onset of strabismus Bilateral cataract (n=64) Unilateral cataract (n=44) Variables Postop. orthotropia Postop. strabismus Postop. orthotropia Postop.strabismus P P (n=53) (n=11) (n=31) (n=13) -20/100 3 5 2 9 20/80-20/40 9 3 14 3 20/32-20/25 24 3 14 1 20/20 16 0 0 0 ≤20/100 3 5 (62.5%) 2 9 (81.8%) 0.003 0.000 >20/100 49 6 (10.9%) 28 4