Timing and approaches in congenital cataract surgery: a four-year, two-layer randomized controlled trial
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Hao-Tian Lin; Wei-Rong Chen; Yi-Zhi Liu. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China. haot.lin@hotmail.com; chenwr_q@aliyun.com; yizhi_liu@aliyun.com

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Supported by the 973 Program (No.2015CB964600); National Natural Science Foundation of China (No.91546101; No.81300750); the Guangdong Provincial Natural Science Foundation for Distinguished Young Scholars (No.2014A030306030); the Tip-top Scientific and Technical Innovative Youth Talents of Guangdong Special Support Program (No.2014TQ01R573); the Clinical Research and Translational Medical Center of Pediatric Cataracts in Guangzhou (No.201505032017516).

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    Abstract:

    AIM: To compare visual prognoses and postoperative adverse events of congenital cataract surgery performed at different times and using different surgical approaches. METHODS: In this prospective, randomized controlled trial, we recruited congenital cataract patients aged 3mo or younger before cataract surgery. Sixty-one eligible patients were randomly assigned to two groups according to surgical timing: a 3-month-old group and a 6-month-old group. Each eye underwent one of three randomly assigned surgical procedures, as follows: surgery A, lens aspiration (I/A); surgery B, lens aspiration with posterior continuous curvilinear capsulorhexis (I/A+PCCC); and surgery C, lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy (I/A+PCCC+A-Vit). The long-term best-corrected visual acuity (BCVA) and the incidence of complications in the different groups were compared and analyzed. RESULTS: A total of 57 participants (114 eyes) with a mean follow-up period of 48.7mo were included in the final analysis. The overall logMAR BCVA in the 6-month-old group was better than that in the 3-month-old group (0.81±0.28 vs 0.96±0.30; P=0.02). The overall logMAR BCVA scores in the surgery B group were lower than the scores in the A and C groups (A: 0.80±0.29, B: 1.02±0.28, and C: 0.84±0.28; P=0.007). A multivariate linear regression revealed no significant relationships between the incidence of complications and long-term BCVA. CONCLUSION: It might be safer and more beneficial for bilateral total congenital cataract patients to undergo surgery at 6mo of age than 3mo. Moreover, with rigorous follow-up and timely intervention, the postoperative complications in these patients are treatable and do not compromise visual outcomes.

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Hao-Tian Lin, Er-Ping Long, Jing-Jing Chen, et al. Timing and approaches in congenital cataract surgery: a four-year, two-layer randomized controlled trial. Int J Ophthalmol, 2017,10(12):1835-1843

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Publication History
  • Received:September 07,2017
  • Revised:October 16,2017
  • Adopted:
  • Online: December 07,2017
  • Published: