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Clinical profile and surgical outcomes in children with posterior lenticonus
Divya Harshwardhan Jain1, Sumita Agarkar1, Hennaav Kaur Dhillon1
1Department of Pediatric Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India.
Insights
Surgery improves vision in children with posterior lenticonus and cataract. Good visual outcomes are possible even with posterior capsule issues, but strabismus may lead to poorer results.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Surgical Outcomes
Background:
- Posterior lenticonus is a rare congenital condition affecting the lens.
- It often leads to cataract formation and visual impairment in children.
- Understanding clinical profiles and surgical outcomes is crucial for management.
Purpose of the Study:
- To describe the clinical characteristics of children with posterior lenticonus.
- To evaluate visual outcomes after surgical intervention in these patients.
- To identify factors influencing postoperative visual acuity.
Main Methods:
- Retrospective review of medical records for posterior lenticonus cases (2000-2016).
- Inclusion criteria: minimum 6-month follow-up post-presentation.
- Data collected: demographics, surgical details (IOL type), amblyopia therapy, preoperative/postoperative visual acuity.
Main Results:
- Study included 48 eyes with posterior lenticonus and adequate follow-up.
- Mean presenting visual acuity improved from 1.034 logMAR to 0.57 logMAR post-surgery.
- Preoperative posterior capsule dehiscence and younger age did not significantly impact final visual acuity.
- Preoperative strabismus showed a borderline correlation with poorer postoperative visual acuity (P=0.049).
Conclusions:
- Surgical intervention with intraocular lens (IOL) implantation significantly improves visual acuity in children with posterior lenticonus and cataract.
- Modern surgical techniques allow successful IOL in-the-bag placement, even with pre-existing posterior capsule defects.
- Children presenting with strabismus alongside posterior lenticonus may experience less favorable visual outcomes.
Aims:
The purpose of this study is to describe the clinical profile of children presenting with posterior lenticonus. We also report on visual outcomes following surgery in these patients.
Subjects And Methods:
Medical records of patients with a diagnosis of posterior lenticonus between January 2000 and December 2016 were reviewed. Data collected included demographic details, preoperative, intraoperative details like type of intraocular lens (IOL) and surgery, and amblyopia therapy. Only the patients with a follow-up of at least 6 months from the time of presentation were included in the analysis.
Results:
Forty-eight eyes with posterior lenticonus with at least 6 months of follow-up were studied. Twelve (25%) eyes had a preoperative posterior capsule (PC) dehiscence as seen on slit-lamp biomicroscopy or on ultrasonography. The mean presenting visual acuity in all eyes was 1.034 ± 0.56 logarithm of the minimum angle of resolution (logMAR) units. The mean final visual acuity in these patients was 0.57 ± 0.5 logMAR units. Postoperative visual acuity was found to have a borderline positive correlation with the presence of preoperative strabismus (P = 0.049). Younger age at presentation (P = 0.533) or the presence of preoperative PC dehiscence (P = 0.735) did not influence final visual acuity.
Conclusion:
Visual acuity improves following surgery with IOL implantation in children with posterior lenticonus and cataract. With the availability of foldable lenses and improved surgical techniques, it is possible to place the IOL in bag despite a preexisting posterior capsular dehiscence. Children with posterior lenticonus who present with strabismus are likely to have poorer visual outcomes.
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