Avaliação paquimétrica da córnea de crianças submetidas a facectomia com implante de lente intraocular
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2020-02-28
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Universidade Estadual Paulista (Unesp)
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Introdução: A catarata na infância é importante causa de deficiência visual. Nesse caso, a cirurgia de catarata deve ser realizada precocemente a fim de evitar o desenvolvimento de ambliopia, porém quanto mais precoce a cirurgia maior o risco de comprometimento de estruturas oculares, como a córnea. Objetivo: avaliar a espessura corneana central (ECC) em crianças com catarata congênita ou do desenvolvimento antes e após facectomia com implante primário de lente intraocular (LIO). Métodos: Trata-se de um estudo longitudinal retrospectivo, realizado por meio da análise de dados pré e pós-operatórios de crianças submetidas a facectomia com implante primário de LIO no período de janeiro/2011 a dezembro/2018. As aferições paquimétricas foram realizadas no pré-operatório, até 6 meses após a cirurgia, de 6 a 12 meses, de 12 a 24 meses e com mais de 24 meses de pós-operatório. Resultados: Foram incluídos 48 pacientes com catarata bilateral, sendo 30 (62,5%) do sexo masculino. A média de idade no momento da cirurgia foi de 3,29 ± 2,85 anos e tempo de seguimento médio de 3,70 ± 2,27 anos. Incluímos 41 pacientes com catarata unilateral, sendo 25 (60,97%) do sexo feminino, 21 casos (51,22%) acometendo olho esquerdo, média de idade no momento da cirurgia de 2,49 ± 2,53 anos e tempo de seguimento médio de 2,47 ± 2,23 anos. Observou-se um aumento estatisticamente significativo da ECC um ano após facectomia em olhos com catarata bilateral em relação à medida pré-operatória (550 µm (528,2 - 571,5) versus 544 µm (523,5 - 567,5), p = 0,002), sendo mais importante em olhos operados no primeiro ano de vida (p = 0,01) em comparação com aqueles operados após um ano de idade (p = 0,04). O aumento da ECC foi ainda mais significativo após dois anos de seguimento pós-operatório (562 µm (538,5 - 582,7), p < 0,001). Nas cataratas unilaterais, a mediana da ECC no pré-operatório foi de 540,0 µm (516,5 - 582,5) nos olhos sadios versus 551,0 µm (520,0 - 581,5) nos olhos afetados, p = 0,450. Não houve diferença significativa entre os valores de paquimetria corneana pré e pós-operatórios nos olhos afetados. Os valores de média e mediana tendem a ser maiores após dois anos de seguimento, porém não houve significância estatística. Conclusão: A ECC de crianças com catarata bilateral aumentou após facectomia com implante de LIO, principalmente naquelas operadas com menos de um ano de idade. Nas cataratas unilaterais não houve diferença significativa entre olhos sadios e olhos afetados, como não houve aumento paquimétrico após facectomia.
Background: Childhood cataract is an important cause of visual impairment. In this case, cataract surgery must be performed early in order to avoid the development of amblyopia, but the earlier the surgery, the greater the risk of compromising ocular structures, such as the cornea. Purpose: To assess preoperative and postoperative central corneal thickness (CCT) in children with congenital or developmental cataract undergoing facectomy with primary intraocular lens (IOL) implantation. Methods: We performed a longitudinal retrospective study, in which pre and postoperative data of children who underwent facectomy with primary IOL implantation from January 2011 to December 2018 were evaluated. CCT measurements were performed preoperatively, and up to 6 months after surgery, 6 to 12 months, 12 to 24 months, and more than 24 months after surgery. Results: We included 48 patients with bilateral cataract, 30 (62.5%) were male, mean age at the time of surgery was 3,29 ± 2,85 years and mean follow-up time was 3,70 ± 2,27 years. Forty-one patients with unilateral cataract, 25 (60.97%) were female, 21 (51.22%) with cataract in the left eye, mean age at the time of surgery was 2,49 ± 2,53 years and mean follow-up time was 2,47 ± 2,23 years. There was a statistically significant increase in CCT one year after facectomy in eyes with bilateral cataract compared to preoperative measurement (550 µm (528.2 - 571.5) versus 544 µm (523.5 - 567.5), p = 0.002), and it was more important in eyes operated in the first year of life (p = 0.01) compared to those operated after one year of age (p = 0.04). The increase in CCT was even more significant after two years of surgery (562 µm (538.5 - 582.7), p < 0.001). In unilateral cataracts, the median preoperative CCT was 540.0 µm (516.5 - 582.5) in healthy eyes versus 551.0 µm (520.0 - 581.5) in affected eyes, p = 0.450. There was no significant difference between pre- and postoperative CCT values in affected eyes. The mean and median values tend to be higher after two years of follow-up, but there was no statistical significance. Conclusion: The CCT of children with bilateral cataract increased after facetomy with IOL implantation, especially in those operated under one year of age. In unilateral cataracts, there was no significant difference between healthy eyes and affected eyes, as there was no pachymetry increase after facectomy.
Background: Childhood cataract is an important cause of visual impairment. In this case, cataract surgery must be performed early in order to avoid the development of amblyopia, but the earlier the surgery, the greater the risk of compromising ocular structures, such as the cornea. Purpose: To assess preoperative and postoperative central corneal thickness (CCT) in children with congenital or developmental cataract undergoing facectomy with primary intraocular lens (IOL) implantation. Methods: We performed a longitudinal retrospective study, in which pre and postoperative data of children who underwent facectomy with primary IOL implantation from January 2011 to December 2018 were evaluated. CCT measurements were performed preoperatively, and up to 6 months after surgery, 6 to 12 months, 12 to 24 months, and more than 24 months after surgery. Results: We included 48 patients with bilateral cataract, 30 (62.5%) were male, mean age at the time of surgery was 3,29 ± 2,85 years and mean follow-up time was 3,70 ± 2,27 years. Forty-one patients with unilateral cataract, 25 (60.97%) were female, 21 (51.22%) with cataract in the left eye, mean age at the time of surgery was 2,49 ± 2,53 years and mean follow-up time was 2,47 ± 2,23 years. There was a statistically significant increase in CCT one year after facectomy in eyes with bilateral cataract compared to preoperative measurement (550 µm (528.2 - 571.5) versus 544 µm (523.5 - 567.5), p = 0.002), and it was more important in eyes operated in the first year of life (p = 0.01) compared to those operated after one year of age (p = 0.04). The increase in CCT was even more significant after two years of surgery (562 µm (538.5 - 582.7), p < 0.001). In unilateral cataracts, the median preoperative CCT was 540.0 µm (516.5 - 582.5) in healthy eyes versus 551.0 µm (520.0 - 581.5) in affected eyes, p = 0.450. There was no significant difference between pre- and postoperative CCT values in affected eyes. The mean and median values tend to be higher after two years of follow-up, but there was no statistical significance. Conclusion: The CCT of children with bilateral cataract increased after facetomy with IOL implantation, especially in those operated under one year of age. In unilateral cataracts, there was no significant difference between healthy eyes and affected eyes, as there was no pachymetry increase after facectomy.
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Lentes intra-oculares, Catarata - Cirurgia, Crianças, Paquimetria corneana, Corneal pachymetry, Cataract extraction, Intraocular lenses, Children