Major Article
Fixation control and eye alignment in children treated for dense congenital or developmental cataracts

This work was presented as a poster at the 37th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, March 30-April 3, 2011, San Diego, California.
https://doi.org/10.1016/j.jaapos.2011.11.007Get rights and content

Background

Many children treated for cataracts develop strabismus and nystagmus; however, little is known about the critical period for adverse ocular motor outcomes with respect to age of onset and duration.

Methods

Children who had undergone extraction of dense cataracts by the age of 5 years were enrolled postoperatively. Ocular alignment was assessed regularly throughout follow-up. Fixation stability and associated ocular oscillations were determined from eye movement recordings at ≥5 years old. Multivariate logistic regression was used to evaluate whether laterality (unilateral vs bilateral), age at onset, and/or duration of visual deprivation were associated with adverse ocular motor outcomes and to determine multivariate odds ratios (ORs).

Results

A total of 41 children were included. Of these, 27 (66%) developed strabismus; 29 (71%) developed nystagmus. Congenital onset was associated with significant risk for strabismus (OR, 5.3; 95% CI, 1.1-34.1); infantile onset was associated with significant risk for nystagmus (OR, 13.6; 95% CI, 1.6-302). Duration >6 weeks was associated with significant risk for both strabismus (OR, 9.1; 95% CI, 1.9-54.2) and nystagmus (OR, 46.2; 95% CI, 6.0-1005). Congenital onset was associated with significant risk for interocular asymmetry in severity of nystagmus (OR, 25.0; 95% CI, 2.6-649), as was unilateral cataract (OR, 58.9; 95% CI, 5.1-2318).

Conclusions

Laterality (unilateral vs bilateral) and age at onset were significant nonmodifiable risk factors for adverse ocular motor outcomes. Duration of deprivation was a significant modifiable risk factor for adverse ocular motor outcomes. The current study demonstrated that reduced risk for nystagmus and strabismus was associated with deprivation ≤6 weeks.

Section snippets

Subjects and Methods

Children treated for dense congenital or developmental cataracts during the first 5 years of life were enrolled following cataract extraction. Participants with cataracts were referred to the study by eight Dallas–Fort Worth area pediatric ophthalmologists. Excluded from participation were children with posterior persistent fetal vasculature, glaucoma, congenital infections, metabolic diseases, syndromes, and developmental delay. Children who experienced sight-threatening intra- or

Results

A total of 41 children were enrolled in the study. Age at presentation, age at surgery, age at outcome test, and visual acuity are provided for each child in e-Supplement 1 and e-Supplement 2 (available at jaapos.org). Of the 41 children, 20 had congenital cataracts and 21 had developmental cataracts (9 infantile and 12 with onset >12 months). Eye alignment and fixation control outcomes are also provided for each child in e-Supplements 1 and 2. Of the 20 children with congenital cataracts, 2

Discussion

There was a high prevalence of postoperative strabismus and nystagmus among children who had extraction of dense cataracts during the first 5 years of life. Congenital onset and visual deprivation >6 weeks were associated with significantly higher risk for strabismus; infantile onset and visual deprivation >6 weeks were associated with significantly higher risk for nystagmus. Congenital onset and unilateral cataracts were associated with higher risk for interocular asymmetry in amplitude or

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    This work was supported by grants from the Gerber Foundation (EEB) and the National Eye Institute EY05236 (EEB).

    The authors have no conflicts of interest to disclose.

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