A COMPARATIVE STUDY OF INCREASE IN CENTRAL CORNEAL THICKNESS FOLLOWING CONGENITAL CATARACT SURGERY IN CHILDREN
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 72
Abstract
BACKGROUND The incidence rate of paediatric cataracts is high in developing countries like India1; about 7.4 - 15.3 % of childhood blindness is due to congenital cataract. Although cataract extraction is performed at early ages in these children to prevent stimulus deprivation amblyopia, other complications such as secondary glaucoma, 2 continue to threaten their long term visual outcome. It was observed that after congenital cataract extraction, the increase in central corneal thickness (CCT) leads to overestimation of Intraocular Pressure (IOP) by Goldman Applanation Tonometry (GAT); and hence overdiagnosis of glaucoma in operated children resulting in unnecessary use of antiglaucoma medications. Aims and Objectives1) To determine the central corneal thickness in children following surgery for congenital cataract in primary/secondary pseudophakia and aphakia and compare with age-matched normal children. 2) To see the variation in central corneal thickness (CCT) following primary/secondary Posterior Chamber Intraocular Lens (PCIOL) implantation for congenital cataract. MATERIALS AND METHODS This is a descriptive comparative study conducted among children under 12 years of age who underwent surgery for congenital cataract, who attended the Outpatient Department (OPD) as well as wards of Department of Ophthalmology and/or Institute of Paediatrics at Government Rajaji Hospital, Madurai. The duration of study was 10 months. Subjects, who fulfilled all eligibility criteria, and none of the exclusion criteria, were only recruited in this study after obtaining written informed consent from their parents/guardian. Out of 170 eyes included in this study, 27 were aphakic, 74 were pseudophakic eyes (46 with primary intraocular lens implantation and 28 with secondary intraocular lens implantation) and 69 unoperated eyes in these subjects were taken as controls as preliminary CCT values were unavailable for the aphakic/pseudophakic eyes. A detailed evaluation of the anterior and posterior segment (dilated fundus examination) was done. Visual acuity was recorded in cooperative children. After explaining both the procedures; IOP & CCT measurement; topical anaesthetic drops (0.5% proparacaine) were instilled into the conjunctival sac. Intraocular pressure was recorded with GAT and in uncooperative children with Perkin’s handheld Applanation tonometer. After 5 minutes, child is reassured and asked to fix at a distant target. CCT was measured using ultrasonic pachymeter by placing the tip of the probe gently on the centre of cornea. An average of 5 readings is taken. Uncooperative children were examined under oral sedatives. After IOP and CCT measurement, these were compared to the IOP and CCT readings of their corresponding age-matched healthy children. RESULTS The age distribution of cases and controls varied from 4 - 12 years. There was no significant difference in age between the study group and control group. Among the 85 children (170 eyes) studied, 52 were male and 33 were female. In the study group, total number of aphakic eyes was 27 and pseudophakic eyes 74. Among them, 46 had IOL implanted at the time of lens extraction (primary pseudophakia) while in 28 cases IOL was implanted on a later date (secondary pseudophakia). The CCT in aphakia group ranged from 540 – 620 µm, mean value being 597 µm. Maximum number of eyes had CCT in the range of 580 – 620 µm. The CCT in pseudophakic group ranged from 480 – 600 µm, mean value in primary pseudophakia being 514 µm and for secondary pseudophakia it was 552 µm. The IOP values in the study group ranged between 12 - 32 mm of Hg, the mean value is 22.88 mm of Hg. Among the 19 aphakic eyes studied, IOP varied from 12 – 32 mm of Hg, mean value being 24 mm of Hg. The IOP measurements in pseudophakic group ranged from 14 – 26 mm of Hg, mean reading being 20 mm of Hg. Corrected IOP values were determined in each study group as per Dresdner CCT - IOP correction table. For aphakics it was 22 mm of Hg, primary pseudophakics 20 mm of Hg and secondary pseudophakics 20 mm of Hg. There was a significant difference in CCT between the study group and control group. There was a significant positive correlation (r = 0.525) between CCT and IOP in the study group. CONCLUSION Children who have undergone lens extraction for congenital cataract are found to have a clinically significant increase in central corneal thickness which can in turn provide overestimated intraocular pressure readings by GAT. Aphakic eyes have a thicker cornea when compared to their pseudophakia counterpart. Measuring central corneal thickness and necessary intraocular pressure corrections should be made mandatory before prescribing anti-glaucoma medications in children who are highly susceptible to their serious side effects.
Authors and Affiliations
Subbiah Vasan Chandrakumar, Sooravali Ibrahim Thasneemsuraiya, Anujoseph Anujoseph, Devadoss Sangeetha, Ganesan Vidhubala, Kannan Shalini, Murugan Uma
Keywords
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- EP ID EP265597
- DOI 10.14260/jemds/2017/1117
- Views 112
- Downloads 0
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