Central corneal thickness following cataract surgery in pediatric patients

Dr.G.Sujatha; Dr.R.Prameela; Dr.Geethika

Volume : VII, Issue : XI, November - 2018

Central corneal thickness following cataract surgery in pediatric patients

Dr. G. Sujatha, Dr. R. Prameela, Dr. Geethika

Abstract :

Introduction-

Childhood Cataract blindness is one of the major avoidable causes of blindness in both developed and developing countries and it is a priority for VISION 2020: The right to sight. Cataracts are reported to be responsible for approximately 20% Of cases of childhood blindness globally. Children with congenital cataracts in the developing world often go untreated for several years unlike in developed countries where they are treated within few months of birth. Lack of awareness, access and monetary resources deprive many blind children of corrective surgery. Their blindness profoundly limits their prospects for education, social integration and eventual employment. Of the 1.4 million blind children globally, the number due to lens-related conditions is estimated to 190,000 (14%). the earlier the cataract is removed and visual rehabilitation is started, the lesser the chances of amblyopia setting in. The goal of the present study was to measure the CCT changes before and after uncomplicated surgery minimal manual clear corneal incision with irrigation and aspiration and IOL implantation in a congenital and developmental cataract case. It looks at the changes taking place in CCT on 1^st post-operative day, 1^st week, 1^st month, 3^rd month and 6^th month following the cataract surgery in children of the age group 6years to 14 years at a tertiary eye care centre in Telangana.

Aim

To evaluate central corneal thickness (CCT) changes before and after uncomplicated congenital and developmental cataract surgery in pediatric patients between 6-14 years of age.

Design- Prospective interventional case study

Material and methods

This study done in pediatric and squint ophthalmic out-patient department at Sarojini Devi Eye Hospital, Hyderabad, Telangana, from November 2015- October 2017. The study group included 80 clinically diagnosed eyes of 50 children with 20 unilateral and 30 bilateral congenital cataracts presenting at the age of 6-14 years. Data of patient�s age, sex, detailed history with regard to onset of cataract and visual difficulties, and family history are noted. All the eyes underwent complete slit lamp examination, fundus examination and subjective refraction, B scan and the CCT changes measured with specular microscopy in all cases preoperatively and postoperatively on 1^stday, 1^st week, 1^stmonth, 3^rdmonth and 6^thmonth. Manual clear corneal incision (minimal incision cataract surgery) with lens matter removal by irrigation and aspiration and IOL implantation done. All the data was recorded and presented as mean. The p-value is calculated using the one sample t-test used on all continuous data to calculate statistically significant difference between pre-operative and post-operative values in same group. The statistical significance difference is taken when p-value <0.05.

Results – The study evaluated 80 eyes of 50 children with 20 unilateral and 30 bilateral congenital cataracts presenting in late childhood of age 6- 14 years which were clinically diagnosed. It was observed that 23 (46%) male and 27 (54%) female were found to have congenital cataract. Age wise, before 10year males- 17 (73.91%) and after 10yr in male- 6 (26.08%), before 10yr female- 16 (59.25%) and after 10year female- 11 (40.74%). The mean CCT before cataract surgery was 533+ 25, and the observations of changes in CCT were as follows 1^st day – 560+20, after 1^st week 550+20, after 1 month 534+25, after 3 month 540+30, and after 6 months 539+30. The preoperative mean endothelial cell count for the entire sample was 2523 cells/mm² and reduced at 6^th month post operatively to 2385 cells/mm². ECL found at 3 months after surgery was (4.43%) and at 6 months after surgery was 1.36% (4.43%-5.79%).

Conclusion

Clear corneal incision with manual irrigation and aspiration provides important benefits of faster visual recovery, shorter surgical time, cost effective and less manipulation and proves to be the safest procedure to be adopted for congenital cataract surgery