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  • Macular thickness can remain altered for 1 year after pediatric cataract surgery

    Cataract/Anterior Segment, Pediatric Ophth/Strabismus, Retina/Vitreous

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    Review of: Longitudinal changes of the macular structure after lens removal combined with anterior vitrectomy after pediatric cataract surgery

    Wang D, Tian T, Wang J, et al. Journal of Cataract & Refractive Surgery, August 2020

    Investigators measured macular thickness changes after lens removal and anterior vitrectomy for cataract in pediatric eyes.

    Study design

    This prospective study enrolled 30 children (40 eyes) aged 3 to 9 years with congenital or developmental cataract who underwent cataract extraction with IOL implantation at the Eye Hospital of Wenzhou Medical University between June 2016 and March 2018. Twenty eyes had unilateral cataract and 20 had bilateral cataract.

    High-definition spectral-domain OCT was used to evaluate macular thickness changes after surgery. Researchers recorded central subfield thickness (CST) and retinal thickness in the Early Treatment Diabetic Retinopathy Study (ETDRS) subfields (inner 1.0–3.0 mm annulus and outer 3.0–6.0 mm annulus) preoperatively as well as at 1, 3, 6, and 12 months postoperatively.

    Outcomes

    The study found that retinal thickness in every subfield significantly thickened at 3 months (all P<0.05). At 3 months, CST was significantly thicker than preoperative readings (228 vs. 240, P=0.005); macular thickness gradually decreased in the following months. The retinal thickness in the inner nasal, inferior, temporal and outer nasal subfields remained statistically significantly thicker at 6 months but returned to preoperative levels in all subfields at 12 months.

    Limitations

    This study did not include patients younger than 3 years, or children with severe cataract or cataract complicated with other diseases. Determining the functional effect and visual impact of these prolonged macular changes following pediatric cataract surgery and whether the changes are something that could be modulated is an important next step.

    Clinical significance

    This study is important because the incidence of cystoid macular edema after pediatric cataract surgery is still not well known. This paper looked at postoperative changes in the macular structures of all ETDRS sections—not just changes in CST—after lens removal and 23-gauge anterior vitrectomy. All ETDRS subfield macular thicknesses showed statistically significant thickening at 3 months postoperatively, and the influence of surgery on the macular thickness lasted until 12 months postoperatively.