Acquired Central Corneal Thickness Increase Following Removal of Childhood Cataracts

doi:10.1016/j.ajo.2010.09.019

American Journal of Ophthalmology

Volume 151, Issue 3, March 2011, Pages 434-441.e1

https://doi.org/10.1016/j.ajo.2010.09.019 Get rights and content

Purpose

To evaluate central corneal thickness (CCT) in children with congenital/developmental cataracts before and after cataract removal, to correlate CCT with corneal diameters before cataract surgery in this same group, and to evaluate CCT over time in a separate group of children who were already aphakic or pseudophakic at study entry.

Design

Longitudinal study.

Methods

Children with cataract (Group 1, with pre-cataract-removal CCT) and aphakia/pseudophakia (Group 2, presenting after cataract removal) were included. CCT measurements were performed using ultrasound pachymetry. Normal fellow eyes of unilaterally affected cases served as controls. In bilateral cases, right eyes were used for analyses.

Results

Group 1 comprised 66 children. Before cataract surgery, unilateral cases (n = 31) showed similar CCT and strong association between the affected and fellow eyes (552.0 ± 32.9 μm vs 550.9 ± 40.4 μm, respectively; r² = 0.71, P = .0001). After cataract surgery, affected eyes (n = 13) showed mean CCT increase of 29.7 ± 43.1 μm (P = .03) while fellow eyes remained unchanged. Similarly, before cataract surgery, bilateral cases (n = 35) showed similar CCT between the right and left eyes. After cataract surgery, mean CCT increase was 27.4 ± 39.4 μm for first operated eyes of bilateral cases (n = 17, P = .01). Group 2 comprised 50 aphakic/pseudophakic children lacking pre-cataract-removal CCT. CCT was higher in eyes with glaucoma vs those without, at both first and last measurements (ΔCCT 58.9 ± 27.0 μm at first examination, P = .034, and 56.4 ± 27.1 μm at last examination, P = .043, respectively). There was no statistically significant CCT change over the study interval (median 28 months) for either Group 2 eyes with or those without glaucoma.

Conclusions

CCT in children with cataracts increases after cataract surgery while the fellow eye remains stable. This increase seems to occur early after surgery, likely remaining stable thereafter, though glaucoma can accentuate the increase.

Section snippets

Methods

THIS IS AN ONGOING, LONGITUDINAL STUDY.

Demographics

There were 66 subjects with pre-cataract-surgery data. Mean age was 39.5 months (range 0.3–133). The gender ratio was 37 male to 29 female. Study subjects included 41 white subjects, 20 black, and 5 children with mixed or unreported race. Thirty-one subjects had unilateral cataracts, while 35 had bilateral cataracts. Mean age at cataract removal was not statistically different between cases with unilateral vs bilateral cataracts (32.5 ± 39.2 months vs 45.7 ± 46.3 months, respectively, P = .21).

Discussion

This longitudinal study of CCT in eyes of children with unilateral and bilateral cataracts demonstrated an increase in CCT in all operated eyes following cataract removal, while unaffected eyes of unilateral cataracts showed stable CCT over the same time. This CCT increase occurred in the absence of glaucoma (8 eyes with post-cataract-removal glaucoma were separately analyzed), since elevated IOP can produce corneal edema known to increase CCT. Indeed, when considering all eyes that had

After graduating with a medical degree from the National University of Singapore, Zena Lim completed her ophthalmology residency and fellowship in Pediatric Ophthalmology and Strabismus at the Singapore National Eye Centre. She subsequently pursued another year of fellowship in the same subspecialty at the Duke University Eye Center, Durham, North Carolina. She is currently back in full-time practice at the Singapore National Eye Centre. Her research interests include pediatric cataract and

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Cited by (30)

Corneal characteristics and OCT-angiography findings in pediatric glaucoma and glaucoma suspects
2023, Journal of AAPOS
To analyze corneal biomechanics, specular microscopy, and optical coherence tomography–angiography findings in children with glaucoma.
Pediatric patients (<18 years of age) with glaucoma (n = 38), increased cup:disk ratio and normal intraocular pressure (IOP) glaucoma suspects (n = 36), and controls (n = 67) were prospectively enrolled. Patients underwent testing with Ocular Response Analyzer, CellChek Specular Microscope, and Heidelberg OCT-A.
Average age of participants was 12.4 ± 3.5 years, with no difference between groups (P = 0.71). Glaucoma patients had undergone more intraocular surgeries (P < 0.0001) and showed worse logMAR visual acuity (P < 0.0001) than suspects or controls. Central corneal thickness (CCT) was greater in glaucoma patients (642.8 ± 85.9 μm [P < 0.0001]) and suspects (588 ± 43.7 μm [P = 0.003]) compared with controls (561 ± 39.9 μm). Corneal hysteresis (CH) was decreased in eyes with glaucoma (10.4 ± 3.0) compared with controls (11.7 ± 1.5 [P = 0.006]), but not suspects (11.3 ± 2.0 [P = 0.1]). Glaucoma patients had lower endothelial cell density (2028.4 ± 862.7 [P < 0.0001]) and greater average cell area (547.2 ± 332.4 [P < 0.0005]) compared with suspects (2919.3 ± 319.1, 347.5 ± 46.2) and controls (2913.7 ± 399.2, 350.8 ± 57.7), but there was no difference in polymegathism (P = 0.12) or pleomorphism (P = 0.85). No differences in vessel density or vessel skeletal density in the retinal vascular complex (P = 0.3077, P = 0.6471) or choroidal vascular complex (P = 0.3816, P = 0.7306) were detected.
Children with glaucoma showed thicker corneas with lower endothelial cell density and greater cell area, but no difference in retinal/choroidal vascular densities compared with suspects and controls.
Preoperative central corneal thickness in eyes with pediatric cataract versus normal fellow eyes
2023, Journal of AAPOS
To compare the preoperative central corneal thickness (CCT) in eyes with unilateral cataract with their normal fellow eyes in the pediatric population.
A retrospective chart review was conducted using the STORM Kids cataract database. Eyes with traumatic cataract, previous surgery or therapeutic manipulation, or age >18 years were excluded. Only eyes with a normal fellow eye were included. The intraocular pressure, age at time of surgery, race, sex, and type of cataract were also extracted from the record.
A total of 70 eyes with unilateral cataract and 70 fellow normal eyes met inclusion criteria. The mean age at the time of surgery was 3.35 years (range, 0.08-15.05). The mean preoperative CCT in the operated eyes was 577 ± 58 μm (range, 464–898 μm). The mean preoperative CCT in fellow eyes was 570 ± 35 μm (range, 485–643 μm). There was no statistically significant difference between the preoperative CCT in cataract eyes versus unaffected fellow eyes (P = 0.183). When stratified by age, the difference in the CCT between cataract and fellow eyes was greatest in the <1 year age group, but was not statistically significant (P = 0.236). The mean preoperative corneal diameter of operative eyes was 11.0 mm (range, 5.5–12.5 mm [n = 68]). The mean preoperative IOP was 15.1 mm Hg (n = 66).
In our study cohort, there was no significant difference in mean preoperative CCT between unilateral pediatric cataract eyes and unaffected fellow eyes.
Visual acuity, refractive error, and regression outcomes in 169 children with high myopia who were implanted with Ophtec-Artisan or Visian phakic IOLs
2021, Journal of AAPOS
To analyze outcomes in a large cohort of spectacle-aversive children with high myopia who were treated by implantation of the Ophtec-Artisan or Visian phakic intraocular lens (pIOL).
Outcome data were collated retrospectively in 78 children (115 eyes) implanted with the Ophtec-Artisan iris-enclaved anterior chamber pIOL and 91 children (154 eyes) implanted with the Visian ICL (intraocular collamer lens) sulcus pIOL. All children had difficulties with spectacle or contact lens wear. Mean age at surgery was 9.9 years; mean follow-up was 3.9 years (range, 0.6-14.1 years).
A total of 248 of 269 eyes (92%) were corrected to within ± 0.5 D of their target value. Spherical correction averaged 12.3 ± 1.0 D. Refractive spherical regression was −0.04 D/year at last follow-up. Uncorrected distance visual acuity improved from an average logMAR 1.8 to 0.4; corrected distance visual acuity improved an average 0.3 logMAR. Of the treated children, 68% had a gain in binocular fusion. Neurobehavioral and/or visuomotor comorbidities were present in 87% of children. Five eyes (2%) developed retinal detachment an average 6 years after implantation. Nine eyes (3%) implanted with the Ophtec-Artisan pIOL required repositioning after trauma.
Implantation of pIOLs in children is an effective method for correcting high myopia in spectacle noncompliant children. Rates of myopic regression after pIOL surgery are substantially lower than those reported for children treated by excimer laser photorefractive keratectomy (PRK). The prevalence of major complications was relatively low in this high-risk population.
Central corneal thickness and intraocular pressure changes after congenital cataract surgery with intraocular lens implantation in children younger than 2 years
2017, Journal of Cataract and Refractive Surgery
Citation Excerpt :
In our study, there was a significant increase in the corneal thickness after 1 year in children younger than 2 years having cataract extraction with IOL implantation. Previous studies3–7 were of smaller groups of children having primary IOL implantation with a shorter follow-up. Goldmann applanation tonometry overestimates IOP in the eyes with increased CCT in adults and in children with normal eyes.8
To evaluate the change in central corneal thickness (CCT) and intraocular pressure (IOP) preoperatively to postoperatively in children younger than 2 years of age having surgery with primary intraocular lens (IOL) implantation for congenital cataract.
Tertiary care institute, Chandigarh, India.
Prospective case series.
Children younger than 2 years old who had phacoaspiration with IOL implantation were studied. The preoperative pachymetry and IOP were compared with the postoperative values at 3 months, 6 months, and 12 months. Pachymetry was measured using an ultrasound pachymeter and IOP with a handheld Perkins applanation tonometer.
Thirty-one patients (aged 3 to 24 months) were analyzed. There were 24 bilateral cases and 7 unilateral cases. The CCT increased significantly from a preoperative value of 529.84 μm ± 11.7 (SD) to a postoperative value of 553 ± 15.5 μm at 1 year (P = .022). The mean increase in CCT was 23.16 μm and in IOP, 2.59 mm Hg. The change in CCT correlated with the change in IOP at 1 year (P = .011).
After cataract surgery, the CCT in pediatric eyes increased significantly. The CCT values were an important consideration in the measurement of IOP in children younger than 2 years having cataract extraction with primary IOL implantation.
Phakic Intraocular Collamer Lens (Visian ICL) Implantation for Correction of Myopia in Spectacle-Aversive Special Needs Children
2017, American Journal of Ophthalmology
A subset of children with high anisometropia or isoametropia and neurobehavioral disorders have chronic difficulties with spectacle or contact lens wear. We report the results of refractive surgery in a series of these children treated using bilateral or unilateral intraocular collamer lens (Visian ICL) implantation for moderate to high myopia.
Prospective nonrandomized cohort study.
Clinical course and outcome data were collated prospectively for 40 implanted eyes in 23 children (mean age 10.2 ± 5.3 years, range, 1.8–17 years). Myopia ranged from −3.0 to −14.5 diopters (D), mean −9.2 ± 3.5 D. Goal refraction was plano to +1 D. Correction was achieved by sulcus implantation of a Visian ICL (STAAR Surgical, Monrovia, California, USA) under general anesthesia. Mean follow-up was 15.1 months (range, 6–22 months).
Thirty-five eyes (88%) were corrected to within ±1.0 D of goal refraction; the other 5 (12%) were corrected to within 1.5 D. Uncorrected distance visual acuity improved substantially in all eyes (from mean 20/1050 [logMAR 1.72] to mean 20/42 [logMAR 0.48]). Spherical regression at last follow-up was an average of +0.59 D. Visuomotor comorbidities (eg, amblyopia, nystagmus, foveopathy, optic neuropathy) accounted for residual postoperative subnormal visual acuity. Thirteen of the 23 children (57%) had a neurobehavioral disorder (eg, developmental delay/intellectual disability/mental retardation, Down syndrome, cerebral palsy, autism spectrum disorder). Eighty-five percent (11/13) of those children were reported to have enhanced visual awareness, attentiveness, or social interactions. Endothelial cell density was measureable in 6 cooperative children (10 eyes), showing an average 1% decline. Central corneal thickness, measured in all children, increased an average of 8 μm. Two children (8%) required unplanned return to the operating room on the first postoperative day to alleviate pupillary block caused by a nonpatent iridotomy. No other complications were encounterd.
Visian ICL implantation improves visual function in special needs children who have moderate to high myopia and difficulties wearing glasses or contact lenses.
Corneal Changes in Children after Unilateral Cataract Surgery in the Infant Aphakia Treatment Study
2015, Ophthalmology
Citation Excerpt :
Thus, it is likely that endothelial function is suboptimal in CL eyes, resulting in the increased CCT. Previous studies have demonstrated that increased CCT is acquired after cataract surgery in infants and is not a congenital anomaly.24 Differences between CL type (Silsoft vs. RGP) were not significant, although only 19% of patients predominantly wore RGP lenses, making statistical evaluation challenging to interpret.
We report endothelial cell (EC) characteristics and central corneal thickness (CCT) from the Infant Aphakia Treatment Study (IATS) patients at the 5-year examination.
Randomized, controlled trial of the treatment of unilateral cataract with aphakic contact lens (CL) versus primary intraocular lens (IOL) implant.
A total of 114 infants with unilateral cataract.
The EC density, coefficient of variation (CV), and percent hexagonal cells were measured by noncontact specular microscopy. The CCT was measured using contact pachymetry. Fellow eyes served as controls.
Mean differences between treated and fellow eyes of CL and IOL groups were compared with a paired t test. A 1-way analysis of variance model and the Tukey–Kramer multiple comparison procedure were used to assess the effect of a diagnosis of glaucoma or glaucoma suspect.
A total of 105 subjects (52 with CLs, 53 with IOLs) had specular microscopy or corneal thickness data recorded. Mean EC densities were higher in aphakic eyes compared with fellow eyes (3921 vs. 3495 cells/mm², P < 0.0001). Mean CV was higher (27 vs. 24, P = 0.0002) and mean percent hexagonal cells was lower (72% vs. 76%, P = 0.002) in aphakic eyes compared with fellow eyes. Mean CCT of aphakic eyes was higher than in controls (637 vs. 563 μm, P < 0.0001). There was no difference in EC density in eyes treated with IOLs compared with fellow eyes (3445 and 3487 cells/mm², P = 0.68). Means for CV (25 vs. 24, P = 0.07) and percent hexagonal cells (74 vs. 76%, P = 0.27) were also not significantly different. Mean CCT was higher in eyes with IOLs (605 vs. 571 μm, P < 0.0001) compared with fellow eyes. Compared with treated eyes without glaucoma or glaucoma suspect, treated eyes with glaucoma had lower EC density (3289 vs. 3783 cells/mm², P = 0.03) and treated eyes with glaucoma suspect had greater mean corneal thickness (660 vs. 612 μm, P = 0.0036).
Cataract extraction during infancy with IOL implantation was not associated with a reduced EC count in treated compared with fellow eyes, although CCT was increased. Extended-wear aphakic CLs may cause corneal polymegathism with increased EC density and CCT. Glaucoma diagnosis was associated with reduced EC counts and increased CCT.

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Original articleAcquired Central Corneal Thickness Increase Following Removal of Childhood Cataracts

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Demographics

Discussion

Surv Ophthalmol

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

J AAPOS

Am J Ophthalmol

J AAPOS

Ophthalmology

Ophthalmology

The Ocular Hypertension Treatment Study: Baseline factors that predict the onset of primary open-angle glaucoma

Arch Ophthalmol

Corneal thickness in congenital glaucoma

J Glaucoma

Decreased central corneal thickness in children with Down syndrome

J Pediatr Ophthalmol Strabismus

Original article
Acquired Central Corneal Thickness Increase Following Removal of Childhood Cataracts