The effect of prior trabeculectomy on refractive outcomes of cataract surgery.

PURPOSE: To examine surgical and refractive outcomes of phacoemulsification with intraocular lens (IOL) implant in eyes with prior trabeculectomy. DESIGN: Retrospective observational case-control study. METHODS: The study compared eyes that underwent phacoemulsification with IOL implant at least 3 months post-trabeculectomy (n = 77) with eyes with either medically controlled glaucoma (n = 43) or no glaucoma (n = 50) at an academic institution. The main outcome measure was the difference between the expected and the actual postoperative refraction. RESULTS: Mean intraocular pressure (IOP) increased in trabeculectomy eyes from 8.7 ± 4.2 mm Hg to 10.7 ± 4.0 mm Hg (P < .0001), whereas it decreased in glaucoma control and normal control groups by 2.0 mm Hg (P = .003) and 2.1 mm Hg (P < .00001), respectively, with concurrent decrease in drops in the glaucoma control group (0.76 to 0.23, P < .0001). The difference from expected refractive outcome was -0.36 (more myopic) in trabeculectomy eyes compared with +0.23 (more hyperopic) in nonglaucoma controls and +0.40 in glaucoma controls (P < .0001). The correlation between change in IOP vs extent of refractive surprise was statistically significant (P = .01, r = -0.20). Final visual acuity was not affected by the difference in refractive error. CONCLUSIONS: The refractive surprise correlated to IOP change, with 2 mm Hg rise resulting in a -0.36 diopter shift between predicted and actual refraction. After cataract extraction, IOP decreased in controls and fewer drops were required, but IOP increased in the study group. Factors affecting refractive surprise in cataract surgery after trabeculectomy, especially IOP change and axial length, require further investigation.

Connected speech intelligibility of children with cochlear implants and children with normal hearing.

The objective of this study was to compare the connected speech intelligibility of children who use cochlear implants with that of children who have normal hearing. Previous research has shown that speech intelligibility improves from before cochlear implantation to after implantation and that the speech intelligibility of children who use cochlear implants compares favorably with that of children who use conventional hearing aids. However, no research has yet addressed the question of how the speech intelligibility of children who use cochlear implants compares to that of children with normal hearing. In the current study, archival data on connected speech intelligibility from 51 children with cochlear implants were compared with newly collected data from 47 children with normal hearing. Results showed that for children with cochlear implants, greater intelligibility was associated with both increased chronological age and increased duration of cochlear implant use. Consistent with previous studies, children with normal hearing achieved adult-like or near-adult-like intelligibility around the age of 4 years, but a similar peak in intelligibility was not observed for the children who used cochlear implants. On the whole, children with cochlear implants were significantly less intelligible than children with normal hearing, when controlling both for chronological age and for length of auditory experience. These results have implications for the socialization and education of children with cochlear implants, particularly with respect to on-time placement in mainstream educational environments with age peers.