Long-term strabismus outcomes after unilateral infantile cataract surgery in the Infant Aphakia Treatment Study
Erick D Bothun1, Marla J Shainberg2, Stephen P Christiansen3
1Department of Ophthalmology, Mayo Clinic, Rochester Minnesota, University of Minnesota, Minneapolis, Minnesota; Department of Ophthalmology and Visual Sciences, University of Minnesota, Minneapolis, Minnesota.
Insights
Strabismus, especially exotropia, is common 10 years after infant cataract surgery, regardless of aphakia management. Better visual acuity at age 10 correlates with improved ocular alignment in these children.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Research
Background:
- Infant cataract surgery requires careful aphakic management.
- Long-term outcomes of strabismus following unilateral cataract surgery in infancy are not fully characterized.
- The Infant Aphakia Treatment Study (IATS) provides a unique dataset for evaluating long-term ocular alignment.
Purpose of the Study:
- To characterize long-term strabismus outcomes in children participating in the Infant Aphakia Treatment Study (IATS).
- To analyze the prevalence and types of strabismus at age 10.5 years in children treated for unilateral congenital cataracts in infancy.
- To investigate the relationship between aphakic management strategies and long-term strabismus development.
Main Methods:
- Secondary data analysis of children from the Infant Aphakia Treatment Study (IATS).
- Inclusion of children aged 10.5 years with a history of unilateral cataract surgery between 1 and 6 months of age.
- Evaluation of ocular alignment, strabismus type, strabismus surgery history, and visual acuity.
Main Results:
- 88% of children developed strabismus by age 10.5 years.
- Exotropia became the most common type of strabismus (45%) at 10.5 years, shifting from esotropia (51%) earlier in childhood.
- Children with orthotropia or microtropia (<10Δ) had significantly better median visual acuity (0.56 logMAR) compared to those with larger angle strabismus (≥10Δ, 1.30 logMAR).
Conclusions:
- Strabismus, particularly exotropia, is a frequent long-term outcome after infant monocular cataract surgery, irrespective of the aphakic management approach.
- The delayed onset of exotropia suggests a need for careful monitoring and management of early-stage esotropia in this population.
- Improved visual acuity at age 10 years is associated with better ocular alignment, highlighting the importance of visual development in strabismus management.
Purpose:
To characterize long-term strabismus outcomes in children in the Infant Aphakia Treatment Study (IATS).
Methods:
This study was a secondary data analysis of long-term ocular alignment characteristics of children aged 10.5 years who had previously been enrolled in a randomized clinical trial evaluating aphakic management after unilateral cataract surgery between 1 and 6 months of age.
Results:
In the IATS study, 96 of 109 children (88%) developed strabismus through age 10.5 years. Half of the 20 children who were orthophoric at distance through age 5 years maintained orthophoria at distance fixation at 10.5 years. Esotropia was the most common type of strabismus prior to age 5 years (56/109 [51%]), whereas exotropia (49/109 [45%]) was the most common type of strabismus at 10.5 years (esotropia, 21%; isolated hypertropia, 17%). Strabismus surgery had been performed on 52 children (48%), with 18 of these (35%) achieving microtropia <10Δ. Strabismus was equally prevalent in children randomized to contact lens care compared with those randomized to primary intraocular lens implantation (45/54 [83%] vs 45/55 [82%]; P = 0.8). Median visual acuity in the study eye was 0.56 logMAR (20/72) for children with orthotropia or microtropia <10Δ versus 1.30 logMAR (20/400) for strabismus ≥10Δ (P = 0.0003).
Conclusions:
Strabismus-in particular, exotropia-is common irrespective of aphakia management 10 years following infant monocular cataract surgery. The delayed emergence of exotropia with longer follow-up indicates a need for caution in managing early esotropia in these children. Children with better visual acuity at 10 years of age are more likely to have better ocular alignment.
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