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Editors Selection IGR 11-1

Examination methods: CCT after congenital cataract surgery

James Brandt

Comment by James Brandt on:

13986 Glaucoma and increased central corneal thickness in aphakic and pseudophakic patients after congenital cataract surgery, Simsek T; Mutluay AH; Elgin U et al., British Journal of Ophthalmology, 2006; 90: 1103-1106


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In this retrospective study of 43 aphakic and pseudophakic eyes following congenital cataract surgery, Simsek et al. (636)examined central corneal thickness (CCT) and a variety of other factors among their subjects and compared them to age- and sex-matched controls. They report that patients who underwent congenital cataract surgery had significantly thicker corneas than controls (626 µm compared to 556 µm; p < 0.05) and interestingly also found a difference between eyes that had undergone primary IOL implantation compared to those that remained aphakic. A negative correlation between the age at lensectomy and CCT was also observed.

The authors postulate that the CCT differences observed in their study (and the difference between pseudophakic and aphakic eyes) might be the result of vitreous factors affecting the microstructure of the anterior segment and normal maturation of the cornea. They do not, however, report the proportion of their aphakic patients managed with contact lenses. Low-grade corneal edema due to chronic contact lens use might explain their results.

Regardless of the underlying pathophysiologic explanation for the findings, this study highlights the fact that the diagnosis of glaucoma in children should not depend on tonometry alone, but should rely on a careful evaluation of the optic nerve, anterior chamber angle and when possible, functional testing. Tonometry in children, difficult under the best of circumstances, is further confounded by abnormal CCTs associated with congenital aphakia and other syndromes such as aniridia.


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