Changes in Refraction following Pediatric Cataract Surgery

PURPOSE: To evaluate the factors influencing the refractive changes and to predict the ideal intraocular lens powers in children who had undergone cataract surgery. METHODS: The medical records of the pediatric patients with aphakia or pseudophakia who were followed for more than 5 years postoperatively were reviewed retrospectively. They were grouped according to the age at surgery and were followed-up every six months postoperatively. The myopic changes and the factors associated with these changes among the groups were evaluated and compared. RESULTS: The follow-up time was 5 years. In the age-matched subset of patients, no statistically significant difference in the refractive change were found between the aphakic and pseudophakic eyes as well as between the unilateral and bilateral cataracts. Children operated on at 1 month to 1 year of age had a mean myopic shift of -5.58D (range -1.88 to -12.85) and children operated on at 1 to 3 years of age had a shift of -4.25D (range -1.78 to -8.71). The mean myopic shift decreased as the age at operation increased. Children operated on at 10 to 15 years of age had a shift of -1.46D (range 0 to -5.28). CONCLUSIONS: During the first 5 years after surgery, no statistically significant difference in refractive change was observed between the aphakic eyes and pseudophakic eyes as well as between the unilateral and bilateral cataracts. The increasing difficulty in deciding the ideal IOL-power is expected in young children as the refractive change becomes more unpredictable when surgery is performed on younger patients.

Optic Nerve Head Analysis Obtained by Optical Coherence Tomography for the Diagnosis of Glaucoma in Koreans

PURPOSE: To find the optimal parameter of the optic nerve head (ONH) analysis using Optical Coherence Tomography (OCT) and to form a diagnostic classification for the detection of glaucoma in Koreans. METHODS: The subjects of this study were 799 eyes of 400 patients at Kangnam St. Mary's Hospital from June 2003 to March 2004. Complete ophthalmic examinations containing the visual field test and OCT ONH analysis (StratusOCT, software ver. 3.0, Carl Zeiss Meditec, Inc, Dublin, CA, USA) were performed and the results were analyzed in the normal, glaucoma suspect and glaucoma groups. RESULTS: In the 799 eyes, there were 378 glaucomatous eyes. There was a statistically significant difference between glaucoma and non-glaucoma patients in all parameters of OCT ONH analysis except for the disc area. The horizontal integrated rim area (HIRA) was most significantly correlated with the visual field indices (MD and CPSD) and was the most useful parameter in glaucoma detection. Based on age and HIRA, the new discriminant formula = -1.858 - 0.028 x Age + 2.518 x HIRA was obtained and its accuracy, sensitivity and specificity were 72.8%, 71.5% and 73.8% respectively. CONCLUSIONS: HIRA was the most useful parameter in the detection of glaucoma. The new discriminant formula from OCT ONH analysis is expected to be useful in the diagnosis and follow-up of glaucoma in Koreans.

Clinical Ability of High Frequency Pattern VEP and Flicker ERG Examination to Detect Glaucomatous Visual Field Change

PURPOSE: We investigated whether pattern visual evoked potential (VEP) and flicker electroretinogram (ERG) are helpful in detecting the progression of glaucomatous field defect on standard automated perimetry. METHODS: We investigated 50 eyes with primary open-angle glaucoma (POAG) (n=18), glaucoma suspect (n=21), and control (n=11) tested with high frequency pattern VEP and flicker ERG at first visit in our hospital from 1998 to 2002. The results were applied as a prospective study. RESULTS: Thirteen eyes (study group) showed progressive defects, whereas 37 eyes (control group) showed no progression. The hit ratio, sensitivity and specificity were 78.0%, 84.6% and 75.7%, respectively, according to retino-cortical time (RCT) of 88 msec using the receiver operating characteristic curves. The mean survival time for the group with RCT less than 88.0 msec (41.95 months) was longer than that for the group with RCT more than 88.0 msec (31.0 months). The group which had more than 88.0 msec in RCT showed a hazard ratio of glaucomatous field defect progression of 7.855 compared to the other group (RCT: difference between P100 latency in VEP and a wave implicit time in ERG). CONCLUSIONS: Our study showed that high frequency pattern VEP and flicker ERG were significant in the progression of glaucomatous field defect.