Strabismus in Cases of Cataract in Pediatric Age Group
22
Table 8. Strabismus compared with the presence of IOL.
SQUINT
IOL NO YES Total
YES 1153 57 1210
NO 112 9 121
Total 1265 66 1331
P = 0.137.
Table 9. Type of strabismus.
TYPE NUMBER (n) PERCENT (%)
ESOTROPIA 35 50.8
VERTICAL 5 7.2
EXOTROPIA 29 42.0
Total 69 100.0
of strabismus, like A pattern, V pattern, or dissociated ver-
tical deviation. In cases with strabismus, 37 (53.6%) had
sensory nystagmus and 56 (81.2%) had amblyopia.
4. Discussion
The enrolled patient group consisted of 1331 eyes in 815
pediatric patients with cataracts. There were 867 (65.1%)
males and 464 (34.9%) females (Table 2). The mean
patient age was 4.1 ± 1.06 (range, 0 - 18) years. Of the
cataracts, 605 (45.5%) were traumatic and 726 (54.4%)
were congenital or developmental. The mean patient age
was 4.1 ± 1.6 years. The mean age in another report was
7.1 [22]. Age at intervention had a significant effect on
visual outcome (Table 2). Other investigators have re-
ported similar findings [23].
The incidence of traumatic cataracts in children was
higher than that reported previously [24]. In a compare-
son of the traumatic and non-traumatic groups, the group
with traumatic cataracts had a significantly lower inci-
dence of strabismus, likely attributable to the more fully
developed visual system in children in traumatic cases.
Spanou et al. reported strabismus in 23% and Magli et al.
reported a 34% incidence of strabismus in contrast to
only 5% in our study [25,26], perhaps because of the
larger number of traumatic cataracts. Regarding unila-
teral and bilateral cases, we found a higher incidence of
strabismus in bilateral cataracts in contrast to another re-
port [25].
A retrospective study of the outcome of surgery for ca-
taracts in the pediatric age group has several limitations.
Although we believe that all patients included in the stu-
dy had congenital, developmental, or traumatic lens opa-
cities, not all patients were seen and followed by us from
the time of birth. In particular, some patients with lamel-
lar cataracts were not seen by us until they were several
years old.
Treatment of strabismic amblyopia following bilateral
congenital cataract surgery is useful, although the ocular
misalignment is sometimes hard to identify, and the am-
blyopia may be profound by the time it is recognized [10,
27]. Deprivational amblyopia due to asymmetry of cata-
racts from the outset is very difficult to reverse, similar to
the situation in patients with monocular congenital cata-
racts. An early start of treatment would seem to be the
only hope of success in these asymmetric cases [10].
In conclusion, the incidence of strabismus in cases of
pediatric cataract was only 5%, was more common in the
non-traumatic group and bilateral cases in the younger
age group. Orthoptic treatment had a significant effect on
visual outcome.
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