The Infant Aphakia Treatment Study: evaluation of cataract morphology in eyes with monocular cataracts

Abstract

Purpose: To describe a video-documented assessment of cataract type in the eyes of patients with monocular infantile cataract who were enrolled in the Infant Aphakia Treatment Study.

Methods: The Infant Aphakia Treatment Study is a randomized clinical trial in which the investigators compared intraocular lens (IOL) versus contact lens correction in 114 infants, aged 28 days to <7 months. A total of 83 videos were available for morphological analysis of cataract. Three examiners reviewed all surgical recordings and agreed on the cataract characteristics by using a score sheet to record the lens layer or configuration of the opacity.

Results: Nuclear cataract was present in 45 of 83 eyes (54%). Posterior capsule plaque was observed in 73 eyes (88%). All eyes with fetal nuclear cataract had associated posterior capsule plaque. Cortical cataract without nuclear involvement was seen in 21 eyes (25%). Posterior bowing of the posterior capsule was noted in 4 eyes (5%). Evidence of persistent fetal vasculature (PFV) was present in 18 eyes (22%). PFV was the only finding in 5 eyes but was also seen in combination with nuclear (7 eyes) and cortical cataracts (6 eyes). The entire lens was white in 3 eyes (4%), whereas the lens was partially resorbed in 7 (8%) eyes. Anterior capsule fibrosis was noted in 5 eyes with advanced cataract (1 with total cataract, 4 with partially resorbed lens).

Conclusions: Nuclear opacities were common, but many different cataract types presented in infancy. PFV occurred in isolation or in association with cataract. Posterior capsule plaque was frequently noted, especially when a nuclear cataract was present.

Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Figures

FIG 1

A, Fetal nuclear cataract with spread into the surrounding cortex. B, Posterior capsule plaque visible after the cataract was aspirated.

FIG 2

A, Cortical cataract with small central posterior plaque. B, Persistent fetal vasculature: mild involvement with a small plaque, a few vessels and a nonpatent hyaloid remnant. C, Persistent fetal vasculature: dense retrolenticular plaque with stretched ciliary processes (arrow) that became visible after cataract aspiration. D, Posterior lentiglobus.

FIG 3

A, Complete cataract. B, Anterior capsule fibrosis (same eye as 3A).