Poster Abstracts
Timing and approaches in congenital cataract surgery:
Published Online
October 30, 2016
*Contributed equally.
State Key Laboratory of
Ophthalmology, Zhongshan
Ophthalmic Center,
Sun Yat-Sen University,
Guangzhou, Guangdong,
510060, China
(Prof W Chen MD, E Long MD
J Chen MD, Z Liu PhD, Z Lin MD,
Q Cao PhD, X Wu MD,
Q Wang PhD, D Lin MD, X Li MD,
Prof L Luo PhD, B Qu PhD,
Prof H Lin PhD, Prof Y Liu PhD).
Correspondence to:
Prof Haotian Lin, State Key
Laboratory of Ophthalmology,
Zhongshan Ophthalmic Center,
Sun Yat-sen University, Xian Lie
South Road 54#, Guangzhou,
Guangdong, 510060,
People´s Republic of China
Zhongshan Ophthalmic Center,
Sun Yat-sen University.
gddlht@aliyun.com
52
a randomised controlled trial
Weirong Chen*, Erping Long*, Jingjing Chen*, Zhenzhen Liu*, Zhuoling Lin, Qianzhong Cao, Xiaohang Wu, Qiwei Wang, Duoru Lin, Xiaoyan Li,
Lixia Luo, Bo Qu, Haotian Lin, Yizhi Liu
Abstract
Background The optimum timing of surgery and the approach that should be used during congenital cataract surgery
are controversial and present challenges for paediatric cataract surgeons in China. The aim of this study was to
compare visual prognoses and postoperative adverse effects of paediatric cataract surgery done at different times and
using different surgical approaches.
Methods In this prospective, randomised controlled trial, we recruited Chinese patients aged 3 months or younger
who were diagnosed with bilateral diffuse or total cataracts, but who did not have coexisting ocular, systemic or
neurological diseases. Patients were randomly assigned into two surgical timing groups: a 3-month-old and a
6-month-old. Each eye had one of three randomly assigned surgical procedures: lens aspiration, lens aspiration with
posterior continuous curvilinear capsulorhexis, and lens aspiration with posterior continuous curvilinear
capsulorhexis and anterior vitrectomy. Long-term visual acuity and incidence of postoperative secondary glaucoma
and severe posterior capsular opacification were the primary outcomes. χ² tests, Fisher’s exact tests and Kruskal-
Wallis tests were used to compare the outcomes between groups. Generalised Estimating Equation with a working
covariance matrix of unstructured correlations was integrated into the multivariate linear regression to explore the
relationship between long-term visual acuity and the incidence of complications. The research protocol was approved
by the Institutional Review Board and Ethics Committee of Sun Yat-sen University. Informed written consent was
obtained from at least one family member of each participating patient, and the study was done according to the
Declaration of Helsinki. This trial is registered with ClinicalTrials.gov, number NCT02581046.
Findings We recruited 61 patients (30 girls, 31 boys) to our study. 4 children were excluded from the final analysis
because their parents declined participation. A total of 57 participants (114 eyes) with a mean follow-up of 48·7 months
were included in the final analysis. Long-term visual acuity in patients who underwent surgery aged 6 months (0·81
[SD 0·28]) was better than that of patients who had surgery aged 3 months (0·96 [0·30], p=0·02) and incidence of
posterior capsular opacification during the 6 months following surgery was positively correlated with long-term visual
acuity (β=-0·080, p=0·036). Two (2/95, 2%) eyes with a confirmed diagnosis of secondary glaucoma were in the
3-month-old group, and additional surgical interventions were done in these patients to lower the intraocular
pressure. For patients who had surgery aged 6 months, the incidence of severe posterior capsular opacification was
significantly higher in the lens aspiration group than other two groups (lens aspiration, 8/15 [53%]; lens aspiration
with posterior continuous curvilinear capsulorhexis, 3/21 [14%]; and lens aspiration with posterior continuous
curvilinear capsulorhexis and anterior vitrectomy, 3/16 [19%]; p=0·03).
Interpretation It was safer and more effective for Chinese bilateral diffuse congenital cataract patients to have surgery
of lens aspiration with posterior continuous curvilinear capsulorhexis with or without anterior vitrectomy at 6 months
of age than at 3 months of age.
Funding National Basic Research Program (973; 2015CB964600); Natural Science Foundation of Guangzhou
(91546101, 81300750); Clinical Research and Translational Medical Center for Pediatric Cataract in Guangzhou,
China.
Contributors
WC, EL, and HL drafted the Abstract. JC and ZL recruited patients and collected data. ZL, QC, XW, and QW did the statistical analyses. DL, XL, LL,
BQ, and HL contributed to study conception. HL and YL provided critical review of the Abstract and approved the final version for submission.
Declaration of interests
We declare no competing interests.
www.thelancet.com