First Author: R.Rebane ESTONIA
Co Author(s): T. Sepp K. Palumaa
Purpose:
To analyse the data of pediatric cataract surgery in East Tallinn Central Hospital Eye Clinic during 2006-2011. We compare the time of operation and anesthaesia during uni or bilateral cataract surgery. Also timing of surgery, visual acuity outcomes and complications will be discussed.
Setting:
There are 1 260 000 blind children all over the world. The main course is congenital cataract. Although there has been a 10% drop during last ten years, there are still 200 000 blind children due to cataract. It is proved, that if the child receives too much general anesthesia under 4 years of age, it may cause dyslexia. That is why the question of simultaneous bilateral cataract surgery in children is an important issue, with pro and contra arguments. Achieving binocularity is a good point, but the risk of infection and IOL calculation could be disadvantages. No study has found a higher incidence of endophthalmitis after simultaneous bilateral cataract surgery, than after unilateral surgery, being 0% - 0,20%. There have been no cases of bilateral endophthalmitis reported in the literature. In our hospital no retrospective analysis on this topic was previously done.
Methods:
Retrospective, consecutive case series were used. Medical records were reviewed for all patients diagnosed with pediatric cataract and operated during 2006-2011.
Results:
24 children (41 eyes) were operated: 13 girls, 11 boys. Bilateral cataracts had 17 children (34 eyes) and unilateral cataract had 7 patients (pt) (7 eyes). Congenital cataract (< 1 years ) had 8 pt (16 eyes), developmental cataract (> 1 years ) 9 pt (18 eyes). All patients were operated under general anesthesia. Mean age at the diagnosis was 2,9 y ( 2 m 12 y ). The mean age at the time of surgery was in bilateral cases 2,75 y ( 3 m 9 y) and bilateral cases, who were operated on in one session 5 m ( 3 11 m ) and unilateral cases 5 y ( 3 m 12 y). Mean time of anesthesia in unilateral cases was 82 min and two eyes in one session 152 min. Mean time of operation in unilateral cases was 42 min and in bilateral cases: in separate sessions 45,3 min and in one session 43,4 min for one eye. 32 eyes with bilateral cataract had BCVA 2 pt 0,1- 0,4, 12 pt 0,4 0,8, 10 pt better than 0,8. In unilateral cases 1 pt 0,05, 2 pt 0,1- 0,4, 2 pt 0,4 0,8.
Conclusions:
Every case of pediatric cataract must be discussed and treated individually. Whether to operate both eyes simultaneously or not, depends on many factors, that should be considered. In bilateral cases there was no statistically significant difference in the operation duration when the eyes are operated in one or in two sessions. There was slightly shorter anesthesia time by simultaneous bilateral surgery (12 min) in our study. Patients with unilateral cataract had more worse BCVA outcome after the operation than patients who had bilateral cataract. In our study there were no severe complications. FINANCIAL DISCLOSURE?: No
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