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Zhang JS, Wang JD, Yusufu M, Cao K, Jin SS, Xiong Y, Li J, Sun XL, Chen SY, Liu ZY, Fu J, Li L, You QS, Wan XH. The effect of retaining intact posterior capsule in congenital cataract surgery in children aged 4-8 years. BMC Ophthalmol 2021; 21:332. [PMID: 34511057 PMCID: PMC8436493 DOI: 10.1186/s12886-021-02098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background The present study sought to observe the effect of retaining intact posterior capsule in congenital cataract surgery in children aged 4–8 years. Methods This is a retrospective case control study. Seventy-seven children (130 eyes) aged from 4 to 8 years who underwent cataract surgery were divided into two groups. In Group A, 50 eyes underwent phacoemulsification, intraocular lens implantation and posterior capsule capsulotomy combined with anterior vitrectomy. In Group B, 80 eyes underwent cataract phacoemulsification and intraocular lens implantation. The postoperative visual acuity and the rate of complications were compared. Results In all patients, cataract surgeries were performed evenly without intraoperative complications. The follow-up time ranged from 6 months to 42 months. No apparent visual axis opacity was detected in group A during the follow-up. By the last visit, apparent visual axis opacity was detected in 31 eyes (38.75%) in group B. Among them, 9 eyes (29.03%) with mild posterior capsule opacification (PCO) were treated with Nd:YAG laser, 3 eyes (9.68%) with thick proliferative membranes were treated with posterior capsule capsulotomy combined with anterior vitrectomy and proliferative membranes in 19 eyes (61.29%) were completely aspired and the posterior capsule was retained. During follow-up, only 2 (6.45%) eyes had PCO recurrence and were treated with Nd:YAG laser. The visual acuity was significantly higher than that before surgery in all patients. Conclusions For older children, the incidence of PCO will be low even if intact posterior capsule is retained. Either Nd:YAG laser or surgical treatment for PCO will be able to maintain good vision.
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Affiliation(s)
- Jing Shang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Jin Da Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Shan Shan Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Ying Xiong
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, 100005, China
| | - Jing Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, 100005, China
| | - Xiu Li Sun
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Shu Ying Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Zhen Yu Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, 100005, China
| | - Li Li
- National Key Discipline of Pediatrics, Ministry of Education, Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Qi Sheng You
- Casey Eye Institute, Oregon Health Science University, Oregon, USA
| | - Xiu Hua Wan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China.
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Sillen H, Van Looveren J, Plaeke P, Van Os L, Tassignon MJ. Real-time intraoperative OCT imaging of the vitreolenticular interface during pediatric cataract surgery. J Cataract Refract Surg 2021; 47:1153-1160. [PMID: 34468452 DOI: 10.1097/j.jcrs.0000000000000609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To report on the use of intraoperative optical coherence tomography (OCT) imaging of the vitreolenticular interface (VLI) during pediatric cataract surgery and to determine the incidence of VLI dysgenesis and surgical difficulties. SETTING Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. DESIGN Retrospective cohort study. METHODS This study included 51 pediatric patients who underwent cataract surgery between April 2016 and December 2018. Video recordings and OCT images of the VLI were analyzed and compared. VLI dysgenesis was considered present when intraoperative OCT images demonstrated partial or total adhesions between the posterior lens capsule and the anterior hyaloid membrane. Video recordings were analyzed to describe surgical difficulties, more specifically: inability to create a calibrated primary posterior continuous curvilinear capsulorhexis (PPCCC), occurrence of vitreous prolapse, need for anterior vitrectomy, and complicated IOL implantation. RESULTS Of the 51 patients included, VLI dysgenesis was demonstrated in 27 patients (52.9%). The incidence of VLI dysgenesis was greater in children with unilateral cataract (72.4%), and children with a posterior capsule plaque (90%). PPCCC was challenging in 20 patients. A defect of the anterior hyaloid membrane was found in 16 patients. Anterior vitrectomy or cutting vitreous strands with scissors was necessary in 10 patients. CONCLUSIONS Intraoperative OCT images were an excellent tool to evaluate the VLI and to demonstrate the presence of VLI dysgenesis during pediatric cataract surgery. Performing a calibrated PPCCC was more challenging in the presence of VLI dysgenesis. This can subsequently expose a defect in the anterior hyaloid membrane, which may result in vitreous prolapse.
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Affiliation(s)
- Hedwig Sillen
- From the Department of Ophthalmology, Antwerp University Hospital, Belgium (Sillen, Van Os, Tassignon); Faculty of Medicine and Health Sciences, University of Antwerp, Belgium (Sillen, Van Looveren, Plaeke, Van Os, Tassignon); Department of Ophthalmology, AZ Klina, Brasschaat, Belgium (Van Looveren); Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium (Plaeke); Department of Ophthalmology, University of Antwerp, Belgium (Van Os, Tassignon)
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Haeussler-Sinangin Y, Schultz T, Holtmann E, Dick HB. Primary posterior capsulotomy in femtosecond laser-assisted cataract surgery: In vivo spectral-domain optical coherence tomography study. J Cataract Refract Surg 2018; 42:1339-1344. [PMID: 27697253 DOI: 10.1016/j.jcrs.2016.06.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/18/2016] [Accepted: 06/24/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate whether the size of Berger space is safely predictable in patients having cataract surgery using 3-dimensional spectral-domain optical coherence tomographic (3-D SD-OCT) image analysis. SETTING Ruhr University Eye Hospital, Bochum, Germany. DESIGN Prospective interventional case series. METHODS Eyes having routine femtosecond laser-assisted cataract surgery were included. After wound closure, the anterior eye segment was visualized using the incorporated 3-D SD-OCT. Visualization of Berger space was performed in the axial and sagittal planes. RESULTS The study comprised 165 consecutive eyes. In 155 eyes, 3-D SD-OCT visualized Berger space and its dimensions were analyzed. In 72% of the cases, Berger space was large enough to perform a femtosecond laser-assisted primary posterior capsulotomy. In 24 eyes (15.5%) with a minimum axial length of 25.0 mm, Berger space was 500 μm or larger. CONCLUSION Femtosecond laser systems incorporating real-time SD-OCT allowed direct visualization of Berger space intraoperatively, providing surgeons with the information needed to safely create posterior capsulotomies after intraocular lens implantation. FINANCIAL DISCLOSURE Dr. Dick is a consultant to Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
| | - Tim Schultz
- From Ruhr University Eye Hospital, Bochum, Germany
| | - Eva Holtmann
- From Ruhr University Eye Hospital, Bochum, Germany
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Van Looveren J, Vael A, Ideler N, Sillen H, Mathysen D, Tassignon MJ. Influence of the vitreolenticular interface in pediatric cataract surgery. J Cataract Refract Surg 2018; 44:1203-1210. [PMID: 30172568 DOI: 10.1016/j.jcrs.2018.06.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/15/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To report the status of Berger space in pediatric cataract cases and the influence of anterior vitreolenticular interface dysgenesis during primary posterior continuous curvilinear capsulorhexis (PCCC). SETTING Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. DESIGN Prospective case series. METHODS The study comprised consecutive pediatric cataract cases planned for bag-in-the-lens intraocular lens (BIL IOL) implantation. A video-based analysis of the surgical interventions included the type of crystalline lens opacification, presence of a posterior capsule plaque (PCP), presence of anterior vitreolenticular interface dysgenesis, complications during primary PCCC, integrity of the anterior hyaloid membrane, need for anterior vitrectomy, and feasibility of BIL IOL implantation. RESULTS Abnormalities in Berger space were observed in 35 of the 64 pediatric cataract cases. Anterior vitreolenticular interface dysgenesis was most often found in cases with persistent fetal vasculature (PFV) and those with posterior cataract. Anterior vitreolenticular interface dysgenesis was diagnosed significantly more often in eyes with unilateral cataract and those with PCP. In pediatric cataract cases presenting with PCP and anterior vitreolenticular interface dysgenesis, the primary PCCC procedure was surgically more demanding, often resulting in detectable breaks in the anterior hyaloid membrane (58.6%) and sometimes necessitating an unplanned anterior vitrectomy (13.8%). Bag-in-the-lens IOL implantation was feasible in all except 1 eye with PFV, which was left aphakic. CONCLUSIONS Primary vitreolenticular interface abnormalities are often encountered during pediatric cataract surgeries, especially when confronted with PCP in a unilateral cataract. The presence of anterior vitreolenticular interface dysgenesis may complicate a primary PCCC procedure, resulting in an unplanned anterior vitrectomy in some cases.
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Affiliation(s)
- Jan Van Looveren
- From the Department of Ophthalmology (Van Looveren, Vael, Mathysen, Tassignon), Antwerp University Hospital, Edegem; and the Faculty of Medicine and Health Sciences (Van Looveren, Vael, Ideler, Sillen, Mathysen, Tassignon), University of Antwerp, Antwerp, Belgium.
| | - Arnout Vael
- From the Department of Ophthalmology (Van Looveren, Vael, Mathysen, Tassignon), Antwerp University Hospital, Edegem; and the Faculty of Medicine and Health Sciences (Van Looveren, Vael, Ideler, Sillen, Mathysen, Tassignon), University of Antwerp, Antwerp, Belgium
| | - Nick Ideler
- From the Department of Ophthalmology (Van Looveren, Vael, Mathysen, Tassignon), Antwerp University Hospital, Edegem; and the Faculty of Medicine and Health Sciences (Van Looveren, Vael, Ideler, Sillen, Mathysen, Tassignon), University of Antwerp, Antwerp, Belgium
| | - Hedwig Sillen
- From the Department of Ophthalmology (Van Looveren, Vael, Mathysen, Tassignon), Antwerp University Hospital, Edegem; and the Faculty of Medicine and Health Sciences (Van Looveren, Vael, Ideler, Sillen, Mathysen, Tassignon), University of Antwerp, Antwerp, Belgium
| | - Danny Mathysen
- From the Department of Ophthalmology (Van Looveren, Vael, Mathysen, Tassignon), Antwerp University Hospital, Edegem; and the Faculty of Medicine and Health Sciences (Van Looveren, Vael, Ideler, Sillen, Mathysen, Tassignon), University of Antwerp, Antwerp, Belgium
| | - Marie-José Tassignon
- From the Department of Ophthalmology (Van Looveren, Vael, Mathysen, Tassignon), Antwerp University Hospital, Edegem; and the Faculty of Medicine and Health Sciences (Van Looveren, Vael, Ideler, Sillen, Mathysen, Tassignon), University of Antwerp, Antwerp, Belgium
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Abstract
Posterior polar cataracts (PPC) have always been a challenge for cataract surgeons due to their inherently higher propensity for posterior capsule rupture. Over the years, several technical modifications have been suggested to enhance safety and reduce posterior capsule rupture rates in these polar cataracts. This review article tries to present the various techniques and strategies to published in literature to manage PPCs. It also discusses pearls for making surgery more reproducible and consistent, as well as the role of newer diagnostic and surgical technology based on the published literature on the subject.
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Intraoperative usefulness and postoperative results of the endoilluminator for performing primary posterior capsulectomy and anterior vitrectomy during pediatric cataract surgery. Eye (Lond) 2014; 28:1008-13. [PMID: 24946844 DOI: 10.1038/eye.2014.136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 05/05/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To analyze the intraoperative usefulness and postoperative results of endoilluminator use during pediatric cataract surgery. METHODS Medical records of children <8 years of age who underwent lens aspiration with primary posterior capsulectomy (PPC) and anterior vitrectomy (AV) with or without intraocular lens implantation (IOL) were studied. An endoilluminator was used intraoperatively as an external light source in all cases to ensure the completeness of PPC and adequacy of AV. All children were divided into three groups depending upon the age at surgery and presence of IOL. We included only the first operated eye in bilateral cases. We studied the intraoperative performance for all and postoperative complications for those with >6 months follow-up. RESULTS The charts of 79 eyes of 46 children (26 boys, 20 girls: 33 bilateral, 13 unilateral) were reviewed, of which we analyzed 46 eyes of 46 children for intraoperative performance and 42 eyes of 42 children for postoperative complications. The intraoperatively adequate size of PPC was obtained in all cases with no vitreous in the anterior chamber. Two cases in the first group developed peaking of the pupil, and one case developed visual axis contraction requiring membranectomy. None of the cases in the other groups developed any complication. CONCLUSION An endoilluminator is a simple, safe, and powerful tool for better visualization of the posterior capsule and anterior vitreous during pediatric cataract surgery. It helps in confirming a good vitrectomy, ensuring its completeness and thereby reducing the chances of any complication due to inadequate AV.
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Abstract
A critical step in phacoemulsification (as well as extracapsular cataract extraction) is making a window in anterior capsule wall (i.e. anterior capsulotomy). Continuous Curvilinear Capsulorhexis (CCC) has become recognized as the standard method of anterior capsulectomy. Techniques employed for CCC have undergone sustained evolution. The present review evaluates elementary principles of CCC. Management of CCC in the presence of small pupil and pseudoexfoliation syndrome is discussed. Main differences of pediatric CCC from its adult-style counterpart and finally several techniques of rescue of an extending capsulorhexis are also reviewed.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Centre, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Sudhalkar AA, Praveen MR, Vasavada VA, Shah SK, Vasavada AR, Vasavada V, Trivedi RH. Subtle signs of an intact anterior vitreous face during pediatric cataract surgery. J Cataract Refract Surg 2012; 38:1690-3. [PMID: 22906451 DOI: 10.1016/j.jcrs.2012.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
We describe the subtle signs of the anterior vitreous face as a bulging structure, a homogenous staining pattern of 3 buttonholes, and a lamellar or fibrillar pattern intact. This should help surgeons correctly recognize the intact anterior vitreous face.
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Affiliation(s)
- Aditya A Sudhalkar
- Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India
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Vasavada AR, Raj SM, Vasavada V, Shrivastav S. Surgical approaches to posterior polar cataract: a review. Eye (Lond) 2012; 26:761-70. [PMID: 22441026 DOI: 10.1038/eye.2012.33] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study is to provide a comprehensive overview of surgical methods used in the emulsification of posterior polar cataracts (PPCs) that have been devised to minimize the risk of posterior capsule rupture (PCR) and its consequences. A Pubmed and Medline search of relevant literature on PPC was done. Only articles relevant to the treatment of PPC were included. The posterior capsule in eyes with PPC are known to have an abnormal adhesion to the polar opacity or a pre-existing weakness of the capsule that predisposes the eye to PCR. To circumvent the consequences of cleaving the abnormal adhesion, a majority of the surgeons use the anterior approach through the limbus, whereas some advocate the posterior approach through the pars plana. Emulsifying the nucleus and cleaving the central opacity of the PPC off the posterior capsule without disrupting its integrity provides optimal surgical outcomes. To achieve this, various modifications have been applied by surgeons during different phases of surgery. The advantages, disadvantages, complications, and results of each method have been discussed. Phacoemulsification is the preferred technique for removing PPC. This review will provide methods to avoid and /or deal with intraocular surgical difficulties that can arise during emulsification. Employing these would result in least ocular morbidity and satisfactory visual outcomes for the patient. This is particularly relevant given the major advancements in technology and refinements in surgical techniques in phacoemulsification.
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Affiliation(s)
- A R Vasavada
- Iladevi Cataract and IOL Research Centre, Raghudeep Eye Clinic, Memnagar, Ahmedabad, India.
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Posterior capsule management in congenital cataract surgery. J Cataract Refract Surg 2011; 37:173-93. [PMID: 21183112 DOI: 10.1016/j.jcrs.2010.10.036] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 06/17/2010] [Accepted: 06/26/2010] [Indexed: 11/20/2022]
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