Results of congenital cataract surgery with and without intraocular lens implantation in infants and children.

BACKGROUND: Operations for congenital cataract in children in the past had resulted in aphakia. Improvement in surgical tools and techniques as well as in intraocular lens (IOL) implantation has led to correction of the aphakia by IOL implantation. We report the outcome of cataract surgery with and without IOL on these children in our institution between 1991-2008. METHODS: In this retrospective cohort study, the medical records of all children who underwent surgery for congenital cataract were reviewed. The final study group included 144 children (218 eyes). Postoperative visual acuity (VA) was tested either by Teller Acuity Cards (in preverbal children) or by the Snellen chart. Data on VA status and postoperative complications were retrieved. RESULTS: Patients with bilateral cataract had better postoperative VA than patients with unilateral cataract (logMAR 0.559 ± 0.455 vs. 0.919 ± 0.685, respectively, P < 0.001). Children who underwent IOL implantation had better postoperative VA than those who did not, but the type of surgery had no significant effect after correction for the child's age at surgery (P = 0.346). Secondary cataract occurred more frequently in the extra-capsular cataract extraction (ECCE) + IOL implantation group than in the ECCE only group (20.6 % vs. 8.3 %, respectively, P = 0.018). CONCLUSIONS: Patients with bilateral cataract had better postoperative VA compared with those with unilateral cataract. The type of surgery had no effect on final VA, but there was a higher rate of secondary cataract in the ECCE + IOL patients compared to the ECCE only patients.

Integration of cochlear-implanted children into the general Israeli community.

BACKGROUND: Severe hearing impairment can have devastating effects on social integration and vocational opportunities. OBJECTIVES: To investigate how well--or poorly--individuals who underwent cochlear implantation as children integrated into the general Israeli hearing community. METHOD: We sent a questionnaire to the 30 subjects > or = 18 years old who underwent cochlear implants in our department from 1990 to 2004 when they were < 18 years of age and had used their device for at least 3 years before replying. RESULTS: Eighteen implant users responded (14 males), yielding a 60% response rate. Their mean age was 13.3 +/- 7.0 years (range 6-17) at implantation and 21.1 +/- 3.6 years (range 18-34) when they filled in the questionnaire. Five were attending rabbinical school (yeshiva students), four were in regular military service, five were university students (three also held jobs), two were attending high school, one was employed (and had a university degree), and one had left the yeshiva and was unemployed when he returned the questionnaire. Fourteen respondents use the oral communication mode for conversation and the other 4 use both oral and sign languages. Longer daily implant use was significantly associated with coping with the difficulties in the setting in which they were currently active, with a higher level of satisfaction with their current lifestyle and with recognition of the implant's contribution to this satisfaction (P = 0.037, P = 0.019 and P = 0.001, respectively). CONCLUSIONS: Advances in cochlear implant technologies enable profoundly deaf implanted children to integrate well into the Israeli hearing society, albeit with a large intersubject variability.