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Koshiishi Y, Nagata M, Matsushima H, Ito S, Suzuki S, Matsumoto H, Okayasu A, Senoo T. Unilateral lifebuoy cataract: A case report. Medicine (Baltimore) 2024; 103:e39359. [PMID: 39151503 PMCID: PMC11332702 DOI: 10.1097/md.0000000000039359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
RATIONALE Lifebuoy cataract is a rare congenital condition characterized by lens thinning. Due to its rarity, detailed treatment reports and standardized surgical approaches are limited. This study aims to enhance the current body of knowledge by presenting comprehensive case reports and describing surgical techniques for the treatment of lifebuoy cataracts. PATIENT CONCERNS A 14-year-old boy was diagnosed with a congenital cataract in his right eye at the age of 9, which was left untreated. The patient visited our hospital due to progressive visual impairment. DIAGNOSES The visual acuity of the right eye was counting fingers at 30 cm. The uncorrected visual acuity of the left eye was 20/100, whereas the best corrected visual acuity was 20/20. The intraocular pressures were 18 mm Hg (left eye) and 20 mm Hg (right eye). Slit-lamp microscopy revealed central calcification of the lens capsule in the right eye and slightly opaque cortical tissue in the periphery, with no observable lens nucleus. Anterior segment optical coherence tomography (CASIA2, TOMEY, Nagoya, Japan) of the right eye showed fused anterior and posterior capsules and an absence of the lens nucleus, leading to a diagnosis of lifebuoy cataract. INTERVENTIONS Cataract surgery was performed on the right eye. Following a 2.4-mm sclerocorneal incision and trypan blue staining, continuous curvilinear capsulorrhexis was performed around the central opacity. The surrounding cortex was removed using irrigation and aspiration, while a viscoelastic agent was injected between the central calcified membrane and the posterior capsule. The membranous tissue was carefully peeled away and removed using forceps. Despite residual posterior capsular opacification, posterior capsulotomy was not performed due to concerns about vitreous prolapse. The intraocular lens was fixed within the capsule. Ten days post-surgery, the remaining posterior capsular opacification was treated with neodymium-doped yttrium aluminum garnet laser capsulotomy. OUTCOMES The uncorrected visual acuity and best corrected visual acuity of the right eye improved to 20/100 and 20/50, respectively. LESSONS This case report demonstrates a successful surgical approach for a lifebuoy cataract, highlighting its unique morphology and the need for careful, specialized techniques. These findings aim to guide ophthalmologists in managing this rare condition, potentially improving patient care.
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Affiliation(s)
- Yuka Koshiishi
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Mayumi Nagata
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Hiroyuki Matsushima
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Sakae Ito
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Shigenari Suzuki
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Haruka Matsumoto
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Akihiko Okayasu
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Tadashi Senoo
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
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Sukhija J, Kaur S, Korla S, Kumari K. Surgical challenges of posterior optic capture in pediatric cataract surgery. Indian J Ophthalmol 2024; 72:51-55. [PMID: 38131569 PMCID: PMC10841806 DOI: 10.4103/ijo.ijo_506_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE The efficacy of posterior optic capture (POC) in reducing posterior capsule opacification (PCO) in pediatric cataract is well recognized. The purpose of this paper was to identify the surgical challenges when attempting this technique and highlight the etiquettes to follow when performing this maneuver. METHODS Prospective observational noncomparative case series. Children diagnosed with congenital or developmental cataracts undergoing cataract surgery and primary IOL implantation with posterior optic capture (and no anterior vitrectomy) from June 2017 to April 2022 at a tertiary care referral institute were included. Records of all intraoperative findings and postoperative complications until the last follow-up were noted. RESULTS Posterior optic capture was attempted in 53 eyes of 49 children aged 2.4 ± 1.98 years. The mean follow-up of the patients was 16.5 ± 14.2 months (range 6 months-5 years). Successful POC could be performed in 46 eyes (86.8%). Two eyes developed posterior capsular opacification at the last follow-up. In eyes where POC could not be performed, five of these (83%) were children below 12 months of age with half of them having a preexisting posterior capsular defect. CONCLUSION Posterior optic capture is technically challenging with a steep learning curve that can be mastered over time. Adequate relative sizing of the anterior and posterior capsulorhexis is important. Caution is advised when using this technique in infants and in cases with posterior capsular defects.
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Affiliation(s)
- Jaspreet Sukhija
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savleen Kaur
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shagun Korla
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kiran Kumari
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Yucel OE, Gul A. Posterior Capsulotomy Size Affects the Formation of Significant Visual Axis Opacification in Congenital and Developmental Cataract. J Pediatr Ophthalmol Strabismus 2023; 60:441-447. [PMID: 36803243 DOI: 10.3928/01913913-20230119-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
PURPOSE To assess the relationship between posterior capsulotomy size and significant visual axis opacification (VAO) in congenital and developmental cataract. METHODS The charts of children aged 7 years and younger who underwent cataract surgery including primary posterior capsulotomy (PPC) and limited anterior vitrectomy between 2012 and 2022 were retrospectively reviewed. Eyes with PPC size smaller than the anterior capsulotomy size were considered as group 1. Eyes with PPC size larger than the anterior capsulotomy size were considered as group 2. Clinical characteristics, the need for Nd:YAG laser treatment or further surgery for significant VAO, and other postoperative complications were compared between the groups. RESULTS Sixty eyes of 41 children were included in the study. The median age at the time of surgery was 5.5 and 3 years in groups 1 and 2, respectively (P = .076). Primary intraocular lens implantation was performed in 23 (85.2%) eyes in group 1 and 25 (75.8%) eyes in group 2 (P = .364). There was no difference between the groups in terms of postoperative visual acuity (P = .983) and refractive errors (P = .154). Eight (29.6%) pseudophakic eyes received Nd:YAG laser treatment in group 1, but none of the eyes in group 2 (P = .001). Four (14.8%) eyes in group 1 and 1 (3%) eye in group 2 underwent further surgery for VAO (P = .100). The need for further intervention for significant VAO was statistically higher in group 1 (44.4% vs 3%, P < .001). CONCLUSIONS Larger PPC size in pediatric cataract may reduce the need for further intervention for significant VAO. [J Pediatr Ophthalmol Strabismus. 2023;60(6):441-447.].
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Singh R, Barker L, Chen SI, Shah A, Long V, Dahlmann-Noor A. Surgical interventions for bilateral congenital cataract in children aged two years and under. Cochrane Database Syst Rev 2022; 9:CD003171. [PMID: 36107778 PMCID: PMC9477380 DOI: 10.1002/14651858.cd003171.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Congenital cataracts are lens opacities in one or both eyes of babies or children present at birth. These may cause a reduction in vision severe enough to require surgery. Cataracts are proportionally the most treatable cause of visual loss in childhood, and are a particular problem in low-income countries, where early intervention may not be possible. Paediatric cataracts provide different challenges to those in adults. Intense inflammation, amblyopia (vision is obstructed by cataract from birth which prevents normal development of the visual system), posterior capsule opacification and uncertainty about the final trajectory of ocular growth parameters can affect results of treatment. Two options currently considered for children under 2 years of age with bilateral congenital cataracts are: (i) intraocular lens (IOL) implantation; or (ii) leaving a child with primary aphakia (no lens in the eye), necessitating the need for contact lenses or aphakic glasses. Other important considerations regarding surgery include the prevention of visual axis opacification (VAO), glaucoma and the route used to perform lensectomy. OBJECTIVES To assess the effectiveness of infant cataract surgery or lensectomy to no surgery for bilateral congenital cataracts in children aged 2 years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 1); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 25 January 2022. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared infant cataract surgery or lensectomy to no surgery, in children with bilateral congenital cataracts aged 2 years and younger. This update (of a review published in 2001 and updated in 2006) does not include children over 2 years of age because they have a wider variety of aetiologies, and are therefore managed differently, and have contrasting outcomes. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. Two review authors extracted data independently. We assessed the risk of bias of included studies using RoB 1 and assessed the certainty of the evidence using GRADE. MAIN RESULTS We identified three RCTs that met our inclusion criteria with each trial comparing a different aspect of surgical intervention for this condition. The trials included a total of 79 participants under 2 years of age, were conducted in India and follow-up ranged from 1 to 5 years. Study participants and outcome assessors were not masked in these trials. One study (60 children) compared primary IOL implantation with primary aphakia. The results from this study suggest that there may be little or no difference in visual acuity at 5 years comparing children with pseudophakia (mean logMAR 0.50) and aphakia (mean logMAR 0.59) (mean difference (MD) -0.09 logMAR, 95% confidence intervals (CIs) -0.24 to 0.06; 54 participants; very low-certainty evidence), but the evidence is very uncertain. The evidence is very uncertain as to the effect of IOL implantation compared with aphakia on visual axis opacification (VAO) (risk ratio (RR) 1.29, 95% CI 0.23 to 7.13; 54 participants; very low-certainty evidence). The trial investigators did not report on the cases of amblyopia. There was little evidence of a difference betwen the two groups in cases of glaucoma at 5 years follow-up (RR 0.86, 95% CI 0.24 to 3.10; 54 participants; very low-certainty evidence). Cases of retinal detachment and reoperation rates were not reported. The impact of IOL implantation on adverse effects is very uncertain because of the sparse data available: of the children who were pseudophakic, 1/29 needed a trabeculectomy and 8/29 developed posterior synechiae. In comparison, no trabeculectomies were needed in the aphakic group and 2/25 children had posterior synechiae (54 participants; very low-certainty evidence). The second study (14 eyes of 7 children under 2 years of age) compared posterior optic capture of IOL without vitrectomy versus endocapsular implantations with anterior vitrectomy (commonly called 'in-the-bag surgery'). The authors did not report on visual acuity, amblyopia, glaucoma and reoperation rate. They had no cases of VAO in either group. The evidence is very uncertain as to the effect of in-the-bag implantation in children aged under 1 year. There was a higher incidence of inflammatory sequelae: 4/7 in-the-bag implantation eyes and 1/7 in optic capture eyes (P = 0.04, 7 participants; very low-certainty evidence). We graded the certainty of evidence as low or very low for imprecision in all outcomes because their statistical analysis reported that a sample size of 13 was needed in each group to achieve a power of 80%, whereas their subset of children under the age of 1 year had only 7 eyes in each group. The third study (24 eyes of 12 children) compared a transcorneal versus pars plana route using a 25-gauge transconjunctival sutureless vitrectomy system. The evidence is very uncertain as to the effect of the route chosen on the incidence of VAO, with no cases reported at 1 year follow-up in either group. The investigators did not report on visual acuity, amblyopia, glaucoma, retinal detachment and reoperation rate. The pars plana route had the adverse effects of posterior capsule rupture in 2/12 eyes, and 1/12 eyes needing sutures. Conversely, 1/12 eyes operated on by the transcorneal route needed sutures. We graded the outcomes with very low-certainty because of the small sample size and the absence of a priori sample size calculation. AUTHORS' CONCLUSIONS There is no high level evidence for the effectiveness of one type of surgery for bilateral congenital cataracts over another, or whether surgery itself is better than primary aphakia. Further RCTs are required to inform modern practice about concerns, including the timing of surgery, age at which surgery should be undertaken, age for implantation of an IOL and development of complications, such as reoperations, glaucoma and retinal detachment. Standardising the methods used to measure visual function, along with objective monitoring of compliance with the use of aphakic glasses/contact lenses would greatly improve the quality of study data and enable more reliable interpretation of outcomes.
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Affiliation(s)
- Ritvij Singh
- Faculty of Medicine, Imperial College London, London, UK
| | - Lucy Barker
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Sean I Chen
- Suite 22, The Galway Clinic, Galway, Ireland
| | - Anupa Shah
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Cochrane Eyes and Vision, Queen's University Belfast, Belfast, UK
| | - Vernon Long
- Ophthalmology Department, St James's University Hospital, Leeds, UK
| | - Annegret Dahlmann-Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Küchlin S, Hartmann ES, Reich M, Bleul T, Böhringer D, Reinhard T, Lagrèze WA. Pediatric cataract surgery: Rate of secondary visual axis opacification depending on intraocular lens type. Ophthalmology 2022; 129:997-1003. [PMID: 35595073 DOI: 10.1016/j.ophtha.2022.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess the time course of secondary visual axis opacification (VAO) that led to additional surgery after primary intraocular lens (IOL) implantation in children and to describe further surgical outcomes. Comparison of different lens types. DESIGN Single center, retrospective analysis of children aged 1-14 years who underwent cataract surgery with primary IOL implantation. The surgical technique was either in-bag IOL placement with primary posterior capsulotomy and anterior vitrectomy or bag-in-lens IOL placement. We excluded eyes with visually significant ocular comorbidities. SUBJECTS Total of 135 eyes of 95 children. Of these, 64 had received an acrylic three-piece IOL, 51 an acrylic single-piece IOL, and 20 an acrylic single-piece bag-in-lens IOL. The median ages at surgery were 53 months (IQR 35-75), 52 months (27-65), and 60 months (40-84) in the 3-piece, 1-piece, and bag-in-lens group, respectively. METHODS Analysis of medical records. We used the Kaplan-Meier method and a cox proportional hazards model with pre-defined adjustments for age at surgery, year of surgery, and socioeconomic deprivation (GISD score by postal code) to analyze VAO-free survival by lens type. Patients were invited to attend a clinical visit to achieve longer follow-ups. MAIN OUTCOME MEASURES The rate of survival without VAO that required clearing of the visual axis after cataract surgery with primary IOL implantation. Any other surgical complications. RESULTS The overall median follow-up was 19 months (IQR 3-58). There were 13 cases of VAO, occurring at a median of 10 months (IQR 10-12) after surgery. Of these, 1 eye had a 3-piece in-bag IOL, 10 eyes had 1-piece in-bag IOLs, and 2 eyes had bag-in-lens IOLs. The adjusted hazard ratio was 32.8 (95% CI: 3.3-327, p=0.003) for 1-piece acrylic IOLs and 19.6 (1.22-316, p=0.036) for bag-in-lens IOLs, compared to 3-piece acrylic in-bag IOLs. Two eyes with bag-in-lens surgery (10%) had an iris capture. There was one case of endophthalmitis. We found no cases of postoperative retinal detachment or new glaucoma. CONCLUSIONS Children with secondary visual axis opacification that required a procedure to clear the visual axis generally presented within fifteen months. Opacification rates were lowest when a 3-piece acrylic IOL was used.
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Affiliation(s)
- Sebastian Küchlin
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Emma Sophia Hartmann
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Pediatric Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Reich
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tim Bleul
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Böhringer
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Posterior continuous curvilinear capsulorhexis with anterior vitrectomy versus optic capture buttonholing without anterior vitrectomy in pediatric cataract surgery. J Cataract Refract Surg 2021; 48:831-837. [PMID: 34670945 DOI: 10.1097/j.jcrs.0000000000000846] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate long-term complications following pediatric cataract surgery with implantation of a heparin-coated PMMA IOL and posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy versus PCCC without anterior vitrectomy with optic capture buttonholing. SETTING Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN Prospective randomized clinical trial. METHODS Eyes with unilateral or bilateral congenital cataract without further pathologies or former surgeries were randomly assigned in two groups: cataract removal, IOL implantation and PCCC with anterior vitrectomy (AV; group A) or posterior optic buttonholing without anterior vitrectomy (optic capture, OC; group B). The main outcome measures were posterior capsule opacification (PCO), complication rates and refractive development. RESULTS 58 eyes of 41 pediatric cataract surgery patients were included. The mean age at time of operation was 66.05 months (± 29.39). In group A (n=26), two eyes required treatment for posterior capsule opacification, whereas the optic axis remained clear in all eyes in group B (n=30), which was not statistically significant. Additionally, group B had a slightly lower rate of complications. Mean SE after a mean postoperative follow-up of 6.5 years was -0.11 ± 2.51 D (-5.0 to +4.0 D) in group A and -0.08 ± 2.14 D (-5.0 to +4.0 D) in group B, which was not statistically significant either. CONCLUSION Optic capture with a heparin-coated PMMA IOL proved to be a safe technique in the prevention of secondary cataract formation without a higher rate of complications and the necessity of vitrectomy.
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Chou YY, Zhang BL, Gan LY, Ma J, Zhong Y. Efficacy of intracameral preservative-free triamcinolone acetonide in pediatric cataract surgery: a meta-analysis. Graefes Arch Clin Exp Ophthalmol 2020; 258:2205-2212. [PMID: 32533281 DOI: 10.1007/s00417-020-04765-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the efficacy of intracameral preservative-free triamcinolone acetonide (TA) on reducing inflammatory reactions after pediatric cataract surgery. METHODS Researches were comprehensively searched in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to 30 November, 2019. Data of interest were extracted and analyzed by Review Manager 5.2. The primary outcome was cell deposits. The secondary outcomes included posterior synechias, fibrinous anterior chamber reaction, visual axis obscuration, and posterior capsule opacification. The odds ratio (OR), weight mean difference (WMD), and their 95% confidence intervals (95% CI) were used to assess the strength of the association. RESULTS In total, 45 articles were obtained. Finally, 5 studies with a total of 308 eyes were enrolled in this meta-analysis. Among these, 134 eyes underwent intracameral TA treatment and 174 eyes did not. In intracameral TA treatment group, the incidence of cell deposits (OR = 0.35, 95% CI 0.16-0.76, P = 0.008), posterior synechias (OR = 0.44, 95% CI 0.23-0.86, P = 0.02), and fibrinous anterior chamber reaction (OR = 0.12, 95% CI 0.01-1.05, P = 0.05) were lower compared to those in patients without intracameral TA treatment. Meanwhile, the incidence of visual axis obscuration (OR = 0.10, 95% CI 0.01-0.85, P = 0.04) and posterior capsule opacification (OR = 0.09, 95% CI 0.02-0.55, P = 0.009) were also reduced significantly. The intraocular pressure (IOP) was evaluated at the first month postoperatively (WMD = 0.84 mmHg, 95% CI 0.14-1.53, P = 0.02), but within the normal range. There was no difference of IOP between two groups at 6 months or above after operation (P = 0.93). CONCLUSIONS The intracameral preservative-free TA in pediatric cataract surgery contributed to much less inflammatory reaction with the normal IOP range.
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Affiliation(s)
- Yu-Yu Chou
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Bi-Lei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lin-Yang Gan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Koch CR, Santhiago MR, Jorge PA, Sena P, Kara-Júnior N. Posterior Capsule Opacification after Cataract Surgery in Children Over Five Years of Age with Square-edge Hydrophobic versus Hydrophilic Acrylic Intraocular Lenses: A Prospective Randomized Study. Clinics (Sao Paulo) 2020; 75:e1604. [PMID: 32401967 PMCID: PMC7196726 DOI: 10.6061/clinics/2020/e1604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/29/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare the effects of hydrophobic and hydrophilic materials in square-edged acrylic intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. METHODS Patients were randomly assigned to group 1 (hydrophobic acrylic square-edged IOLs; 13 eyes) or group 2 (hydrophilic acrylic square-edged IOLs; 13 eyes). The study evaluated PCO rates using Evaluation of Posterior Capsule Opacification (EPCO) 2000 software at one, three, six and 12 months postoperatively. Postoperative measurements also included corrected distance visual acuity (CDVA), neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy and postoperative complications other than PCO. RESULTS Both groups had significant increases in PCO rates after one year. Comparison of the groups showed no significant differences in the EPCO scores at three (group 1, 0.007±0.016 vs group 2, 0.008±0.014; p=0.830), six (group 1, 0.062±0.103 vs group 2, 0.021±0.023; p=0.184), or twelve months postoperatively (group 1, 0.200±0.193 vs group 2, 0.192±0.138; p=0.902). We also found no significant group differences regarding the change (delta, Δ) in EPCO scores between three and six months (group 1, 0.055±0.09 vs group 2, 0.013±0.02; p=0.113) or between six and twelve months postoperatively (group 1, 0.139±0.14 vs group 2, 0.171±0.14; p=0.567). Twenty-three percent of patients required Nd:YAG capsulotomy at the twelve-month visit. CONCLUSIONS No differences in PCO rates were found between hydrophobic and hydrophilic acrylic square-edged IOLs in children between five and twelve years of age at one year of follow-up.
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Affiliation(s)
- Camila Ribeiro Koch
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Humberto Castro Lima, Salvador, BA, BR
- Corresponding author. E-mail:
| | - Marcony R Santhiago
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- University of Southern California Roski Eye Institute, Los Angeles, CA, USA
- Departamento de Oftalmologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
| | - Priscilla A Jorge
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo Sena
- Hospital Humberto Castro Lima, Salvador, BA, BR
| | - Newton Kara-Júnior
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Kekunnaya R. Commentary: To capture or not in pediatric cataract surgery? Indian J Ophthalmol 2019; 68:89. [PMID: 31856477 PMCID: PMC6951165 DOI: 10.4103/ijo.ijo_1561_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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10
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Posterior capsule opacification rate after phacoemulsification in pediatric cataract: Hydrophilic versus hydrophobic intraocular lenses. J Cataract Refract Surg 2019; 45:1380-1385. [DOI: 10.1016/j.jcrs.2019.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/02/2019] [Accepted: 05/12/2019] [Indexed: 11/22/2022]
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Zhang J, Hussain A, Yue S, Zhang T, Marshall J. Osmotically induced removal of lens epithelial cells to prevent PCO after pediatric cataract surgery: Pilot study to assess feasibility. J Cataract Refract Surg 2019; 45:1480-1489. [PMID: 31564322 DOI: 10.1016/j.jcrs.2019.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Development of an osmotic-shock technique to remove human lens epithelial cells (LECs) as a preventive measure to address posterior capsule opacification (PCO) after pediatric cataract surgery. SETTING Department of Genetics, UCL Institute of Ophthalmology, London, England, and Department of Ophthalmology, Ruijin Hospital, Jiao Tong University, Shanghai, China. DESIGN Laboratory study. METHODS Various tissue preparations of human LECs (cultured on coverslips/collagen-coated membrane inserts, human lens capsule biopsies, and lens organ cultured PCO models) were subjected to a single or incremental hyperosmotic shock (NaCl, 350-4000 mOsm/L) in the presence of inhibitors of the Na+-K+-2Cl- cotransporter (NKCC) (to disable the regulatory volume increase [RVI] process). The integrity of the cell monolayer was determined by phase-contrast microscopy, viability assays, and measurement of transepithelial resistance. RESULTS Hyperosmotic shock (400 mOsm/L) caused rapid cell shrinkage (<5 minutes) in all the LEC models studied. In the absence of the NKCC inhibitor, the shrunk cells gradually returned to their original cell volume and architecture over time, while still exposed to the hyperosmotic shock. However, inhibition of the RVI process disabled the ability for restoration of cell volume leading to persistent cell shrinkage, subsequently resulting in cell detachment from the underlying support medium. CONCLUSION Hyperosmotic shock in the presence of inhibitors of the RVI process was effective in rapidly detaching LECs from their basement membranes. This technique could potentially facilitate removal of residual LECs left on the lens capsule after cataract surgery, thus decreasing or eliminating the risk for aggressive cell proliferation and the development of PCO.
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Affiliation(s)
- JinJun Zhang
- Department of Genetics, UCL Institute of Ophthalmology, London, England.
| | - Ali Hussain
- Department of Genetics, UCL Institute of Ophthalmology, London, England
| | - Sun Yue
- Department of Genetics, UCL Institute of Ophthalmology, London, England; Department of Ophthalmology, Ruijin Hospital, Jiao Tong University, Shanghai, China
| | - Tao Zhang
- Department of Genetics, UCL Institute of Ophthalmology, London, England
| | - John Marshall
- Department of Genetics, UCL Institute of Ophthalmology, London, England
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Koch CR, Kara N, Santhiago MR, Morales M. Comparison of different surgical approaches for pediatric cataracts: complications and rates of additional surgery during long-term follow-up. Clinics (Sao Paulo) 2019; 74:e966. [PMID: 31365618 PMCID: PMC6644500 DOI: 10.6061/clinics/2019/e966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To compare long-term postoperative complications of pediatric cataract surgery with primary intraocular lens (IOL) implantation associated with posterior capsulotomy (PC) and anterior vitrectomy (AV) between patients treated with a corneal or pars plicata/pars plana approach. METHODS Children who underwent cataract surgery with in-the-bag primary IOL implantation were divided into two groups according to PC and AV surgical approach: a corneal approach (group 1) and a pars plicata/pars plana approach (group 2). Only patients with a follow-up duration of more than two years were included. Long-term surgical outcomes were retrospectively reported. RESULTS The mean follow-up period was 10.00±3.13 years. No cases of glaucoma or retinal detachment were reported. The mean age at surgery was 34.57±22.66 months. Forty-six children were included (27 eyes in group 1 and 29 eyes in group 2). The most frequent postoperative complication was corectopia, followed by visual axis opacification. Both complications occurred more frequently in group 1 (p<0.001). After cataract surgery, the rate of additional surgeries in group 1 was 51.9%, while in group 2, the rate was 27.6% (p=0.1132). CONCLUSION The pars plicata/pars plana approach with PC and vitrectomy with primary in-the-bag IOL implantation for pediatric cataracts is a safe procedure.
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Affiliation(s)
- Camila R Koch
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Sant Joan de Déu Hospital, Barcelona, Spain
- *Corresponding author. E-mail:
| | - Newton Kara
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcony R Santhiago
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- University of Southern California Roski Eye Institute, Los Angeles, CA, USA
- Departamento de Oftalmologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
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Mohammadpour M, Shaabani A, Sahraian A, Momenaei B, Tayebi F, Bayat R, Mirshahi R. Updates on managements of pediatric cataract. J Curr Ophthalmol 2018; 31:118-126. [PMID: 31317088 PMCID: PMC6611931 DOI: 10.1016/j.joco.2018.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 11/02/2018] [Accepted: 11/14/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose A comprehensive review in congenital cataract management can guide general ophthalmologists in managing such a difficult situation which remains a significant cause of preventable childhood blindness. This review will focus on surgical management, postoperative complications, and intraocular lens (IOL)-related controversies. Methods Electrical records of PubMed, Medline, Google Scholar, and Web of Science from January 1980 to August 2017 were explored using a combination of keywords: "Congenital", "Pediatric", "Childhood", "Cataract", "Lens opacity", "Management", "Surgery", "Complication", "Visual rehabilitation”, and "Lensectomy". A total number of 109 articles were selected for the review process. Results This review article suggests that lens opacity obscuring the red reflex in preverbal children and visual acuity of less than 20/40 is an absolute indication for lens aspiration. For significant lens opacity that leads to a considerable risk of amblyopia, cataract surgery is recommended at 6 weeks of age for unilateral cataract and between 6 and 8 weeks of age for bilateral cases. The recommended approach in operation is lens aspiration via vitrector and posterior capsulotomy and anterior vitrectomy in children younger than six years, and IOL implantation could be considered in patients older than one year. Most articles suggested hydrophobic foldable acrylic posterior chamber intraocular lens (PCIOL) for pediatrics because of lower postoperative inflammation. Regarding the continuous ocular growth and biometric changes in pediatric patients, under correction of IOL power based on the child's age is an acceptable approach. Considering the effects of early and late postoperative complications on the visual outcome, timely detection, and management are of a pivotal importance. In the end, the main parts of post-operation visual rehabilitation are a refractive correction, treatment of concomitant amblyopia, and bifocal correction for children in school age. Conclusions The management of congenital cataracts stands to challenge for most surgeons because of visual development and ocular growth. Children undergoing cataract surgery must be followed lifelong for proper management of early and late postoperative complications. IOL implantation for infants less than 1 year is not recommended, and IOL insertion for children older than 2 years with sufficient capsular support is advised.
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Affiliation(s)
- Mehrdad Mohammadpour
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirreza Shaabani
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sahraian
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Momenaei
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Tayebi
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Bayat
- Ophthalmology Department and Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Outcome of various Hydrophobic Acrylic Intraocular Lens Implantations in Children with Congenital Cataract. Eur J Ophthalmol 2018; 27:711-715. [PMID: 28430328 DOI: 10.5301/ejo.5000969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate performance of different intraocular lenses (IOLs) after cataract surgery in children aged less than 2 years with regards to rates of visual axis opacification (VAO). METHODS This was a retrospective chart review of children <2 years of age undergoing cataract surgery with primary posterior capsulotomy, anterior vitrectomy, and IOL over a period of 5 years with minimum follow-up of 1 year at a tertiary care institute. Children with microphthalmos, persistent fetal vasculature, traumatic cataract, aphakia, secondary IOLs, or any other coexisting ocular disease were excluded. RESULTS A total of 257 eyes of 159 children were included in the study. The mean age at the time of surgery was 11.63 ± 7.916 months (range 6-23 months). A total of 29 eyes of 16 children underwent phacoaspiration with implantation of SA60 AT (AcrySof, Alcon, Fort Worth, TX); 75 eyes of 45 children received Hoya IOL (Hoya-PS AF-1 Series, Model PC-60AD, Hoya, Japan), 70 eyes of 46 patients received Sensar (Abbott Medical Optics Inc., Santa Ana, CA, USA), and 83 eyes of 52 children received MA60AC (AcrySof). At mean follow-up of 18.31 ± 15.04 months, 22.46% of the patients required resurgery for visual axis obscuration. By multiple regression analysis, the rate of visual axis obscuration was affected by the rate of perioperative complications (p = 0.001) and not affected by age (p = 0.98), type of IOL (p = 0.104), or site of IOL implantation (p = 0.603). CONCLUSION Our findings suggest comparable rates of VAO for children less than 2 years of age receiving different types of hydrophobic acrylic IOLs.
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15
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Abstract
The visual outcome of uveitic cataract surgery depends on the underlying uveitic diagnosis, the presence of vision-limiting pathology and perioperative optimization of disease control. A comprehensive preoperative ophthalmic assessment for the presence of concomitant ocular pathology, with particular emphasis on macula and optic nerve involvement, is essential to determine which patients will benefit from improved vision after cataract surgery. Meticulous examination in conjunction with adjunct investigations can help in preoperative surgical planning and in determining the need for combined or staged procedures. The eye should be quiescent for a minimum of 3 months before cataract surgery. Perioperative corticosteroid prophylaxis is important to reduce the risk of cystoid macular edema and recurrence of the uveitis. Antimicrobial prophylaxis may also reduce the risk of reactivation in eyes with infectious uveitis. Uveitic cataracts may be surgically demanding due to the presence of synechiae, membranes, and pupil abnormalities that limit access to the cataract. This can be overcome by manual stretching, multiple sphincterotomies or mechanical dilation with pupil dilation devices. In patients <2 years of age and in eyes where the inflammation is poorly controlled, intraocular lens implantation should be deferred. Intensive local and/or oral steroid prophylaxis should be given postoperatively if indicated. Patients must be monitored closely for disease recurrence, excessive inflammation, raised intraocular pressure, hypotony, and other complications. Complications must be treated aggressively to improve visual rehabilitation. With proper patient selection, improved surgical techniques and optimization of peri- and post-operative care, patients with uveitic cataracts can achieve good visual outcomes.
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Affiliation(s)
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore 168751, Singapore
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16
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Zhao YE, Gong XH, Zhu XN, Li HM, Tu MJ, Coursey TG, Pflugfelder SC, Gu F, Chen D. Long-term outcomes of ciliary sulcus versus capsular bag fixation of intraocular lenses in children: An ultrasound biomicroscopy study. PLoS One 2017; 12:e0172979. [PMID: 28301497 PMCID: PMC5354427 DOI: 10.1371/journal.pone.0172979] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/12/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the long-term outcomes of ciliary sulcus versus capsular bag fixation of intraocular lenses (IOLs) in children after pediatric cataract surgery. Methods IOL was implanted in the ciliary sulcus in 21 eyes of 14 children, and in the capsular bag in 19 eyes of 12 children for the treatment of pediatric cataract in an institutional setting. Ultrasound biomicroscopy (UBM) was performed. Main outcome measures included IOL decentration, IOL tilt, anterior chamber depth (ACD), angle-opening distance at 500 μm (AOD500), trabecular-iris angle (TIA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and incidence of postoperative complications. Results The mean follow-up period was 6.81 ± 1.82 years. Comparing to the capsular bag fixation group, the ciliary sulcus fixation group had higher vertical IOL decentration, horizontal IOL tilt, and vertical IOL tilt (p = 0.02, 0.01,0.01, respectively), higher incidence of iris-IOL contact and peripheral anterior synechia (p = 0.001, 0.03, respectively), smaller ACD, AOD500, and TIA (p = 0.02, 0.03, 0.04, respectively), higher mean IOP (17.10 ±6.06 mmHg vs.14.15± 4.74 mmHg, p = 0.01), and higher incidence of secondary glaucoma (28.57% vs. 10.53%, p = 0.007).There was no significant difference between the two groups with regard to the BCVA, refractive errors, incidence of myopic shift, nystagmus, strabismus, and visual axis opacity. Conclusions Ciliary sulcus fixation of IOLs in pediatric eyes may increase IOL malposition and crowding of the anterior segment, and may associate with a higher risk of secondary glaucoma compared to capsular bag fixation of IOLs.
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Affiliation(s)
- Yun-e Zhao
- Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xian-hui Gong
- Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xue-ning Zhu
- Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - He-ming Li
- Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meng-jun Tu
- Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Terry G. Coursey
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Stephen C. Pflugfelder
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Feng Gu
- Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- * E-mail: (DC); (FG)
| | - Ding Chen
- Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- * E-mail: (DC); (FG)
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Tsai TH, Tsai CY, Huang JY, Hu FR. Outcomes of pediatric cataract surgery with triamcinolone-assisted vitrectomy. J Formos Med Assoc 2017; 116:940-945. [PMID: 28254265 DOI: 10.1016/j.jfma.2017.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE To evaluate outcomes in pediatric patients undergoing lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy for congenital cataract. METHODS This retrospective study included 34 patients younger than 72 months who underwent lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy with or without intraocular lens (IOL) implantation for cataract at the National Taiwan University Hospital from July 2006 to December 2012. RESULTS Fifty-one eyes from 34 patients with cataract (unilateral in 17 patients, bilateral in 17 patients) were included. The mean age at surgery was 26.74 months (range: 2-72 months). The mean postoperative follow-up was 27.8 months (range: 6-72 months). Primary IOL implantation was performed in 25 eyes, 21 of which had the IOL implanted in the capsular bag. Fifty eyes had a central round pupil. The median logarithm of the minimum angle of resolution visual acuity was 0.3 in patients with unilateral cataract and 0.1 in those with bilateral cataract. Three eyes (5.9%) developed visual axis opacification (VAO) and required further surgery. Univariate analysis using Fisher's exact test indicated that surgery in the first 12 months of life was significantly associated with development of VAO (p=0.047). The incidence of postoperative VAO was approximately 15.8% in this age group. CONCLUSION Triamcinolone-assisted vitrectomy can be used in pediatric cataract surgery without serious long-term adverse effects. While the incidence of VAO is low, it appears unavoidable in approximately one-sixth of patients who undergo surgery before 12 months of age.
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Affiliation(s)
- Tzu-Hsun Tsai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Chia-Ying Tsai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Jehn-Yu Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China.
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The long-term anterior segment configuration after pediatric cataract surgery and the association with secondary glaucoma. Sci Rep 2017; 7:43015. [PMID: 28220849 PMCID: PMC5318954 DOI: 10.1038/srep43015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/18/2017] [Indexed: 11/09/2022] Open
Abstract
Secondary glaucoma constitutes major sight-threatening complication of pediatric cataract surgery, yet the etiology remains unclear. The purpose of this study was to investigate the long-term anterior segment configuration and the association with secondary glaucoma in pediatric pseudophakia. Ultrasound biomicroscopy (UBM) was performed on 40 eyes of 26 children underwent pediatric cataract surgery and intraocular lens (IOL) implantation. The anterior chamber depth (ACD), angle-opening distance at 500 μm (AOD500), trabecular-iris angle (TIA), central corneal thickness (CCT), structural abnormities, IOL position, IOP, and incidence of glaucoma were evaluated. High insertion of iris, in which the iris root is attached more anteriorly than normal, was seen in 13 eyes (32.50%). IOL was located in the capsular bag in 19 eyes and in the ciliary sulcus in 21 eyes. Logistic regression analysis identified high insertion of iris (OR 3.40, 95% CI 1.03-11.17, p = 0.03) and IOL implantation in sulcus (OR 1.39, 95% CI 1.07-4.85, p = 0.04) as independent risk factors for glaucoma. The presence of high insertion of iris and IOL implantation in ciliary sulcus may increase the long-term risk of the development of secondary glaucoma after pediatric cataract surgery.
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Lotfy A, Abdelrahman A. Trypan blue-assisted posterior capsulorhexis in pediatric cataract surgery. Clin Ophthalmol 2017; 11:219-222. [PMID: 28182152 PMCID: PMC5279846 DOI: 10.2147/opth.s123150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of staining the posterior capsule with trypan blue during capsulorhexis in pediatric cataract surgery. PATIENTS AND METHODS This was a prospective randomized comparative study carried out at Alpha Vision Center, Zagazig, Egypt. This study included 2 groups of children with pediatric cataract randomly allocated to undergo irrigation and aspiration. In the trypan group, which included 11 eyes, trypan blue was used to stain the posterior capsule during posterior capsulorhexis. In the control group, which included 10 eyes, no staining was performed. All surgeries were performed by the same surgeon. The 2 groups were compared for criteria such as completion of capsulorhexis, disruption of vitreous face and in-the-bag intraocular lens implantation. RESULTS This study included 21 eyes of 16 patients (age range: 6 months-4 years). A statistically significant difference was observed for the following parameters between the 2 groups: capsulorhexis completion (P=0.04), vitreous face disruption (P=0.01) and in-the-bag intraocular lens implantation (P=0.022). CONCLUSION This study suggests that staining of the posterior capsule during capsulorhexis in pediatric cataract operation gives better results than capsulorhexis without staining. The stain changes the capsule texture making capsulorhexis easier with fewer complications.
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Affiliation(s)
- Ayman Lotfy
- Ophthalmology Department, Zagazig University Hospital
- Alpha Vision Center, Zagazig, Egypt
| | - Ayman Abdelrahman
- Ophthalmology Department, Zagazig University Hospital
- Alpha Vision Center, Zagazig, Egypt
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Vasavada AR, Vasavada V. Current Status of IOL implantation in pediatric eyes: an update. Expert Rev Med Devices 2017; 14:1-9. [PMID: 28042714 DOI: 10.1080/17434440.2016.1271706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/09/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Pediatric cataracts are a huge problem worldwide, and with improving techniques and technology, the surgical treatment and postoperative visual rehabilitation are improving. Despite intraocular lenses(IOLs) being the standard of care for adult cataract surgery, this issue is still somewhat controversial, particularly in young children and infants due to lack of unequivocal evidence. This review therefore summarises the findings from recent studies on the aspect of IOL implantation in pediatric eyes. Areas covered: An extensive literature search was undertaken for published articles on congenital/developmental pediatric cataracts, and IOL implantation, where literature pertinent to traumatic and subluxated cataracts was not included in the review. Pubmed was used for literature search, and keywords entered were : pediatric, cataract surgery, intraocular lens, persistent fetal vasculature, outcomes, complications, visual performance with intraocular lenses. Expert commentary: Recent literature supports IOL implantation in most cases of congenital / developmental pediatric cataracts, and it seems like the way forward. However, the jury is still out on IOL implantation in infants, particularly in bilateral cataracts. Thus, surgeons must be extremely cautious in planning primary IOL implantation in infant eyes, and if they do perform IOL implantation, rigorous followup is mandatory.
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Affiliation(s)
- Abhay R Vasavada
- a Iladevi Cataract & IOL Research Centre, Raghudeep Eye Hospital , Ahmedabad , India
| | - Vaishali Vasavada
- a Iladevi Cataract & IOL Research Centre, Raghudeep Eye Hospital , Ahmedabad , India
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Revisiting secondary capsulotomy for posterior capsule management in pediatric cataract surgery. J AAPOS 2016; 20:506-510. [PMID: 27712997 DOI: 10.1016/j.jaapos.2016.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/23/2016] [Accepted: 06/26/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the development and treatment of visual axis opacification following pediatric cataract extraction with intraocular lens placement (IOL) without primary posterior capsulotomy and anterior vitrectomy (PPC+AV). METHODS The medical records of children who underwent cataract extraction and IOL at an academic medical center were reviewed retrospectively for development of posterior capsular opacification (PCO) to identify risk factors for development of treatment-requiring posterior capsular opacification. RESULTS A total of 63 eyes of 47 children 7 months to 16 years of age were included. The rate of PCO formation following cataract extraction without PPC+AV was 90%. Of those, 96% required a secondary capsular procedure to clear the visual axis; 55% had a clear visual axis after 1 procedure, almost exclusively with a YAG capsulotomy, and 3.5% did not require any secondary capsular procedure. Younger age was the only statistically significant characteristic associated with both PCO formation and need for more than one secondary capsular procedure. Children <3 years of age had an average of 2.1 capsular procedures. CONCLUSIONS Cataract extraction and IOL without PPC+AV leads to an expected high rate of PCO formation, which can be effectively managed with a secondary capsular procedure in all age groups. Leaving the posterior capsule intact at primary surgery is an option to discuss with parents to avoid a more complicated primary surgery.
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Surgery for sight: outcomes of congenital and developmental cataracts operated in Durban, South Africa. Eye (Lond) 2015; 30:406-12. [PMID: 26611841 DOI: 10.1038/eye.2015.211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 08/27/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To study the visual outcomes of congenital and developmental cataract surgery and determine variables for presentation for pediatric cataract surgery in KwaZulu Natal province of South Africa. METHODS Care-givers of children presenting with cataract to a quaternary centre were asked when they first detected the condition. The reasons for delay between detection and surgery were studied. The children underwent a comprehensive eye examination and then appropriate surgery. They were prospectively followed up for 3 months and visual acuity and stereopsis were noted. Delay in presentation for surgery and visual outcomes were co-related with demographic and clinical factors. RESULTS Eighty-three non-traumatic cataract surgeries in 50 children were studied. Twenty-six (52%) were males, mean age was 3 years 10 months (SD 3yrs 4 months). The mean delay between identification and surgery was 20.7 months (SD 18 months). Twenty-six (52%) children had >15 months interval between diagnosis and surgery. Only mother's occupation was significantly associated with delay (P=0.017). Post-surgery 17/69 (24.7%) had visual acuity ≥6/18, 20/69 (29.0%) had vision between 6/24-6/60, whereas 32/69 (46.3%) had visual acuity ≤6/60. The final vision was associated with age (P=0.031), delay between diagnosis and surgery (P<0.001), type of surgery (P=0.046) and preoperative vision (P<0.001). CONCLUSION Although the children's vision improved substantially, a longer follow-up and amblyopia treatment would be necessary to optimize the visual outcome, which depended on age and preoperative vision. Health promotion activities aimed at mothers are important in improving visual outcomes.
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Abstract
A 5-year-old boy was referred to our clinic due to an abnormal visual acuity test at school. His corrected visual acuity was counting fingers in the left eye. A nasal side deficiency of the lens substituted by a membrane was found. Lens coloboma was diagnosed. After making a 3 mm limbal incision, the colobomatous lens was removed by anterior continuous curvilinear capsulorhexis and lens aspiration. Posterior capsulorhexis and anterior vitrectomy on the side of the lens was performed to prevent posterior capsular or anterior hyaloid opacity. As the defect in the lens was very large, intracapsular placement of an intraocular lens was not feasible. A three-piece acrylic soft intraocular lens was placed in the ciliary sulcus. Since amblyopia was diagnosed by poor corrected visual acuity as 20/800 1 month after the operation, occlusion therapy with correcting eyeglasses was started at 6 h a day on the contralateral eye. The patient's corrected visual acuity improved to 20/125 7 months after the operation.
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Affiliation(s)
- Jia-Kang Wang
- Department of Medicine, National Yang Ming University, Taipei, Taiwan Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Sheng-Hsiang Ma
- Department of Medicine, National Yang Ming University, Taipei, Taiwan
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Shah MA, Shah SM, Patel KD, Shah AH, Pandya JS. Maximizing the visual outcome in traumatic cataract cases: The value of a primary posterior capsulotomy and anterior vitrectomy. Indian J Ophthalmol 2014; 62:1077-1081. [PMID: 25494250 PMCID: PMC4290198 DOI: 10.4103/0301-4738.146757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: The objective was to provide evidence-based care for patients with traumatic cataracts, we assessed whether a posterior capsulotomy and anterior vitrectomy, as part of the primary surgical procedure, could be a positive predictor of final visual outcome. Materials and Methods: This is a prospective randomized control trial. Patients presenting at our hospital between January 2010 and December 2012 having ocular trauma and traumatic cataracts were enrolled, according to the inclusion criteria. We enrolled two groups: Those with and without primary posterior capsulotomy and vitrectomy. Information regarding demographic and ocular trauma were collected using the World Eye Trauma Registry form at the first visit and follow-up, and specific information was collected for both the group who underwent posterior capsulectomies and vitrectomies as a part of the primary procedure, and the control group. Data were analyzed to evaluate the predictive value of primary posterior capsulectomy and anterior vitrectomy. Results: We enrolled 120 cases, 60 in each group, comprising 31 females and 89 males. When all other variables were controlled for, the visual outcome (best corrected visual acuity) differed significantly (P < 0.001) between the groups. Conclusion: Performance of posterior capsulectomy and anterior vitrectomy as part of the primary procedure improves the final visual outcome.
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Affiliation(s)
- Mehul A Shah
- Department of Vitreo Retinal, Drashti Netralaya, Dahod, Gujarat, India
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Gupta R, Ram J, Sukhija J, Singh R. Outcome of paediatric cataract surgery with primary posterior capsulotomy and anterior vitrectomy using intra-operative preservative-free triamcinolone acetonide. Acta Ophthalmol 2014; 92:e358-61. [PMID: 24730623 DOI: 10.1111/aos.12375] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 01/29/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the intra-operative and postoperative outcome of paediatric cataract surgery with primary posterior capsulotomy (PPC) and anterior vitrectomy using intra-operative preservative-free triamcinolone acetonide. METHODS In this prospective, interventional case-control study, 20 Children who underwent cataract surgery for both eyes were enrolled and their eyes were randomized into two groups. Group A consists of 20 eyes in which standard phacoaspiration with PPC with intracameral triamcinolone was used, and Group B consists of 20 eyes in which triamcinolone were not used. Intra-operative complications and postoperative outcome like intraocular pressure (IOP), posterior synechiae, pigment deposits and posterior capsule opacification (PCO) were studied. RESULTS In both groups, age range varied between 2-8 years comprising 18 males and two females. The mean postoperative IOP did not show any significant variation during 6-month follow-up. In study group, all the 20 eyes were quiet at 2 weeks, while there was cellular reaction 1+ in four eyes (20%) and nil in 16 eyes (80%) at 2 week in the control group (p = 0.035). Pigment deposits on IOL optic was seen in two eyes (10%) of the study group while in control group, IOL deposits were present in 14 eyes (70%) (p = 0.001). Posterior capsule opacification was seen in two eyes (10%) in control group at 3 months while none occurred in study group. CONCLUSIONS Intra-operative use of preservative-free triamcinolone acetonide led to less anterior chamber inflammation and pigment deposits on IOL optic postoperatively compared to those eyes where it was not used.
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Affiliation(s)
- Rohit Gupta
- Department of Ophthalmology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Jagat Ram
- Department of Ophthalmology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Jaspreet Sukhija
- Department of Ophthalmology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Rishiraj Singh
- Department of Ophthalmology; Post Graduate Institute of Medical Education and Research; Chandigarh India
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Hydrophobic acrylic versus polymethyl methacrylate intraocular lens implantation following cataract surgery in the first year of life. Graefes Arch Clin Exp Ophthalmol 2014; 252:1443-9. [PMID: 24947548 DOI: 10.1007/s00417-014-2689-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/25/2014] [Accepted: 05/28/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate complication rates following implantation of hydrophobic acrylic versus polymethyl methacrylate (PMMA) intraocular lens (IOL) with cataract surgery in infants. METHODS Records of children undergoing cataract surgery with IOL implantation in first year of life were retrospectively reviewed. Infants were divided into two groups--hydrophobic acrylic IOLs were implanted in group A, and PMMA IOLs in group B. Outcome measures included incidence of complications, additional surgical procedures, and refractive error changes. RESULTS One hundred and thirteen eyes of 113 children (75 males) with mean age of 6.49 ± 3.56 months were included. Group A included 62 eyes, and group B included 51 eyes. The two groups did not differ significantly in terms of age and axial length. There was no significant difference between the groups for incidence of posterior capsular opacification (PCO), pupillary membranes, glaucoma, fibrin on IOL surface or IOL malposition (p = 0.09). Development of PCO was delayed in group A (p = 0.049). Thirteen eyes of group A and 18 eyes of group B required additional surgical intervention (p = 0.20) in the follow-up visits. CONCLUSION Comparable complications may be expected in infants with PMMA and hydrophobic acrylic lenses. Children implanted with PMMA IOLs may require earlier surgical re-intervention for PCO.
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Gogate PM, Sahasrabudhe M, Shah M, Patil S, Kulkarni AN, Trivedi R, Bhasa D, Tamboli R, Mane R. Long term outcomes of bilateral congenital and developmental cataracts operated in Maharashtra, India. Miraj pediatric cataract study III. Indian J Ophthalmol 2014; 62:186-95. [PMID: 24618489 PMCID: PMC4005236 DOI: 10.4103/0301-4738.128630] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 03/15/2013] [Indexed: 11/05/2022] Open
Abstract
AIM To study long term outcome of bilateral congenital and developmental cataract surgery. SUBJECTS 258 pediatric cataract operated eyes of 129 children. MATERIALS AND METHODS Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF) were noted for before and after surgery. STATISTICS Statistical analysis was done with SPSS version 16 including multi-variate analysis. RESULTS Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years) at the time of surgery. 74/129 (57.4%) were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years). 177 (68.6%) eyes had vision <3/60 before surgery, while 109 (42.2%) had best corrected visual acuity (BCVA) >6/18 and 157 (60.9%) had BCVA >6/60 3-8 years after surgery. 48 (37.2%) had binocular stereoacuity <480 sec of arc by TNO test. Visual outcome depended on type of cataract (P = 0.004), type of cataract surgery (P < 0.001), type of intra-ocular lens (P = 0.05), age at surgery (P = 0.004), absence of post-operative uveitis (P = 0.01) and pre-operative vision (P < 0.001), but did not depend on delay (0.612) between diagnosis and surgery. There was a statistically significant improvement for all the 20 questions of the LVP-CVF scale (P < 0.001). CONCLUSION Pediatric cataract surgery improved the children's visual acuity, stereo acuity and vision function. Developmental cataract, use of phacoemulsification, older children and those with better pre-operative vision had betterlong-termoutcomes.
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Affiliation(s)
- Parikshit M Gogate
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
- Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
- D.Y.Patil Medical College, Pimpri, Pune, Maharashtra, India
| | | | - Mitali Shah
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
| | - Shailbala Patil
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
| | - Anil N Kulkarni
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
- Dr. Kulkarni Eye Hospital, Miraj, District Sangli, Maharashtra, India
- Department of Ophthalmology, BhartiVidyapeeth Medical College, Vishrambaug, Sangli, Maharashtra, India
| | | | - Divya Bhasa
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
| | - Rahin Tamboli
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
| | - Rekha Mane
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
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Bilateral implantation of multifocal versus monofocal intraocular lens in children above 5 years of age. Graefes Arch Clin Exp Ophthalmol 2014; 252:441-7. [PMID: 24441952 DOI: 10.1007/s00417-014-2571-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/27/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate visual results and complications after bilateral implantation of multifocal versus monofocal intraocular lens (IOL) in children above five years of age. METHODS In this prospective non-randomized controlled trial, children with bilateral developmental cataract above five years of age were divided into two groups - Group A implanted with multifocal IOL (both refractive and diffractive) and Group B implanted with monofocal IOL in both eyes. Outcome measures of best corrected visual acuity (BCVA) for distance, distance-corrected near visual acuity (DCNVA), mean refractive spherical equivalent (MRSE), contrast sensitivity, stereopsis and complications such as posterior capsular opacification (PCO) and glare were analyzed using the Mann-Whitney U and the Wilcoxon Signed Rank tests. RESULTS Forty-two eyes of 21 children (mean age: 7.19 years, range: 5-12 years) were included in the study. Group A included 14 eyes (seven children) Group B included 28 eyes (14 children). Both groups showed significant improvement in BCVA at one year follow-up, but no significant difference was found on comparing contrast sensitivity. Stereopsis was slightly better in Group A (125.71 arc-sec) as compared to Group B (140 arc-sec) (p = 0.280). Most patients in Group A were spectacle-independent for near (71.4 %) versus Group B. MRSE at one year was 0.21 in Group A and 0.5 in Group B. Incidence of PCO was similar in either groups (35.7 %). No intraoperative complication was noted in any child. CONCLUSION Multifocal IOL implantation is a viable option in children above five years of age with bilateral cataract.
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Secondary membrane formation after cataract surgery with primary intraocular lens implantation in children. Int Ophthalmol 2013; 34:767-72. [DOI: 10.1007/s10792-013-9873-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/13/2013] [Indexed: 10/26/2022]
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Hafidi Z, Ibrahimy W, Ahid S, Handor H, Cherkaoui LO, Bencherif Z, Laghmari M, Ouazzanni B, Boutimzine N, Daoudi R. [Visual prognosis and refractive outcome after congenital cataract surgery with primary implantation: a study of a series of 108 cases]. Pan Afr Med J 2013; 16:51. [PMID: 24672622 PMCID: PMC3964010 DOI: 10.11604/pamj.2013.16.51.2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 10/02/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Zouheir Hafidi
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Wafaa Ibrahimy
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Samir Ahid
- Université Mohammed V Souissi, laboratoire de biostatistiques, faculté de médecine, Rabat, Maroc
| | - Hanan Handor
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Lalla Ouafae Cherkaoui
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Zahid Bencherif
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Mina Laghmari
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Btissam Ouazzanni
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Noureddine Boutimzine
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Rajae Daoudi
- université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
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Ram J, Sukhija J, Thapa BR, Arya VK. Comparison of hospital versus rural eye cAMP based pediatric cataract surgery. Middle East Afr J Ophthalmol 2012; 19:141-6. [PMID: 22346130 PMCID: PMC3277013 DOI: 10.4103/0974-9233.92131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: To compare the outcomes of pediatric cataract surgery with intraocular lens (IOL) implantation in an eye camp setting and tertiary care center. Materials and Methods: Children aged 5-16 years with visually significant cataract underwent phacoaspiration with IOL implantation in an eye camp (eye camp group) or tertiary care center (TCC group). All surgeries incorporated contemporary microsurgical techniques with implantation of polymethyl-methacrylate (PMMA) IOL. Major postoperative complications were managed at a tertiary care center. Postoperative complications, visual acuity and compliance were evaluated using the Chi-square test. A P value less then 0.05 was considered as statistically significant. Results: The cohort comprised 59 children in the eye camp group and 48 children in the TCC group. Thirty two of fifty nine (54.23%) eyes in the eye camp group and 30/48 (62.5%) eyes in the TCC group achieved 20/40 or better best corrected visual acuity (BCVA) postoperatively. Postoperatively, 36 (61%) eyes in the eye camp group and 22 (45.83%) eyes in the TCC group required Nd: YAG laser capsulotomy or a pars plana membranectomy. (P> 0.05) The most striking feature was loss to follow up. In the eye camp group, loss to follow was 20% at one year, 49% at two years, 62% at 3 years and 67% at 4 years compared to 12.5, 21, 27 and 33% respectively in the TCC group (P<0.05, all cases). Conclusions: The outcomes of camp and tertiary care center (hospital) based pediatric cataract surgery were similar. However, the major drawback of camp based surgery was loss to follow up which eventually affected the management of amblyopia and postoperative complications.
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Affiliation(s)
- Jagat Ram
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Evereklioglu C, İlhan Ö. Do Non-Steroidal Anti-Inflammatory Drugs Delay Posterior Capsule Opacification After Phacoemulsification in Children? A Randomized, Prospective Controlled Trial. Curr Eye Res 2011; 36:1139-47. [PMID: 21978235 DOI: 10.3109/02713683.2011.609304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Division of Cataract and Refractive Surgery, Erciyes University Medical Faculty,
Kayseri, Turkey
| | - Özgür İlhan
- Department of Ophthalmology, Division of Cataract and Refractive Surgery, Erciyes University Medical Faculty,
Kayseri, Turkey
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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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Bhusal S, Ram J, Sukhija J, Pandav SS, Kaushik S. Comparison of the outcome of implantation of hydrophobic acrylic versus silicone intraocular lenses in pediatric cataract: prospective randomized study. Can J Ophthalmol 2010; 45:531-6. [DOI: 10.3129/i10-045] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Tassignon MJ, Gobin L, De Veuster I, Godts D. [Advantages of the bag-in-the-lens intraocular lens in pediatric cataract surgery]. J Fr Ophtalmol 2009; 32:481-7. [PMID: 19717210 DOI: 10.1016/j.jfo.2009.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 06/26/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the advantages of the bag-in-the-lens intraocular lens in children undergoing cataract surgery. PATIENTS AND METHODS This prospective study included 54 eyes of 37 children and babies (age, 2 months to 14 years), consecutively operated on between December 1999 and January 2008 for unilateral or bilateral cataract using the "bag-in-the-lens" intraocular lens. Slit-lamp examination, intraocular pressure, visual acuity, and refraction were followed to the best possible degree over time. RESULTS The mean age of the 37 children at the last consultation visit was 8.3+/-4.9 years. The mean visual acuity improved from 0.2+/-0.1 to 0.8+/-0.3. On the other hand, visual acuity improvement in children presenting hyperplastic persistence of the vitreous was less favorable with a postoperative average visual acuity of 0.14+/-0.18. The mean postoperative refraction in 13 children (26 eyes) operated on for bilateral cataract was 0.5+/-1.5 D for eyes showing axial lengths with substantial variation. The refraction was stable over time in children over 2 years of age. Once the implant was positioned correctly, the remaining epithelial cells of the lens did not migrate toward the visual axis, which was the case in 93.8% of all eyes and in 100% of children over 1 year of age. CONCLUSIONS The "bag-in-the-lens" implant is particularly indicated in children in whom posterior rhexis and optic capture have been recommended since 1994. The implantation minimizes the use of anterior vitrectomy in pediatric cataract surgery, limiting it to those eyes presenting a proliferative hyperplastic vitreous.
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Affiliation(s)
- M-J Tassignon
- Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium.
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Astle WF, Alewenah O, Ingram AD, Paszuk A. Surgical outcomes of primary foldable intraocular lens implantation in children. J Cataract Refract Surg 2009; 35:1216-22. [DOI: 10.1016/j.jcrs.2009.02.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 02/26/2009] [Accepted: 02/28/2009] [Indexed: 11/30/2022]
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Onol M, Ozdek S, Aktas Z, Hasanreisoglu B. Long-term results of pars plana lensectomy with double-capsule-supported intraocular lens implantation in children. Can J Ophthalmol 2008; 43:673-7. [PMID: 19020633 DOI: 10.3129/i08-139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND To report the long-term results of the pars plana lensectomy with double-capsule-supported intraocular lens implantation technique for the treatment of pediatric cataracts. METHODS A lensectomy and an anterior vitrectomy were performed through the pars plana approach, followed by implantation of a posterior chamber intraocular lens (IOL) to the sulcus over the capsules. Patients with a minimum follow-up of 5 years were included in the study and patient data were collected retrospectively from the patient reports. RESULTS Sixteen eyes of 10 patients with a mean age of 4.3 (SD 1.1) years were included in the study. Only one case was traumatic, and the others were congenital cataract cases. A 6.5 mm polymethyl methacrylate posterior chamber IOL was used in all cases. The visual axis was clear in all the cases through the mean follow-up period of 79.2 (SD 14.1) months. IOL decentration was observed in 1 eye at postoperative month 24, and it needed to be repositioned. There was no posterior capsular opacification in any of the cases. Best-corrected visual acuity was 20/40 or better in 81.3% of the eyes. INTERPRETATION The pars plana lensectomy with double-capsule-supported intraocular lens implantation technique seems to be a safe and easy method in children, limiting postoperative IOL-related complications and posterior capsule opacification in the long term.
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Affiliation(s)
- Merih Onol
- Department of Ophthalmology, Gazi University Medical Faculty, Ankara, Turkey
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Xie L, Huang Y. Pars plana capsulectomy and vitrectomy for posterior capsular opacification in pseudophakic children. J Pediatr Ophthalmol Strabismus 2008; 45:362-5. [PMID: 19043948 DOI: 10.3928/01913913-20081101-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of pars plana capsulectomy and vitrectomy for posterior capsular opacification (PCO) in pseudophakic children. METHODS Pars plana capsulectomy and vitrectomy was performed for PCO in 63 pseudophakic eyes of 57 children with an infusion through sutureless clear cornea. The patients' ages ranged from 3 to 12 years (mean: 5.8 +/- 1.9 years). Surgical technique, intraoperative and postoperative complications, visual acuity, intraocular pressure (IOP), and corneal endothelial cell density were recorded. RESULTS The surgical procedure was performed uneventfully in all patients. The mean follow-up was 2.4 +/- 1.4 years (range: 6 months to 5.2 years). During the follow-up period, no incision leakage or other complications were noted and no eye developed recurrent PCO. All eyes had an improvement of visual acuity. Mean postoperative IOP was 13.8 +/- 2.6 mm Hg (range: 8 to 19 mm Hg). Mean overall endothelial cell loss was 3.4%. CONCLUSIONS Pars plana capsulectomy and vitrectomy with an infusion through sutureless clear cornea appears to be a safe and effective approach for thick PCO in pseudophakic children.
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Affiliation(s)
- Lixin Xie
- State Key Lab Cultivation Base, Shandong Provincial Key Lab of Ophthalmology Shandong Eye Institute, Qingdao, Peoples Republic of China
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Luo Y, Lu Y, Lu G, Wang M. Primary posterior capsulorhexis with anterior vitrectomy in preventing posterior capsule opacification in pediatric cataract microsurgery. Microsurgery 2008; 28:113-6. [PMID: 18220313 DOI: 10.1002/micr.20460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Our study was performed to investigate the operative effects of pediatric cataract surgery with anterior vitrectomy. The study comprised of 38 pediatric patients aged 2-5 years and involved a total of 60 eyes with congenital cataracts. The study was done between March 2004 and December 2005. Posterior capsulorhexis with anterior vitrectomy was performed on 34 eyes of 20 children, and cataract extraction was performed on 26 eyes of 18 children. The percentages of various complications and rate of neodymium YAG (Nd:YAG) laser capsulotomy were followed up for 12-36 months. There were significant differences in the percentages of posterior capsule opacification (PCO) and rate of neodymium YAG (Nd:YAG) capsulotomy between the anterior vitrectomy group and cataract extraction group (P < 0.01). The anterior vitrectomy group was associated with less posterior capsular opacification (11.8%) than the cataract extraction group (76.9%). The YAG capsulotomy rate was 2.9% for the anterior vitrectomy group, and 57.7% for the cataract extraction group. After operation the fibrous exudates in anterior chamber and the intraocular lens subluxation or capture were 5.9% and 2.9% for the anterior vitrectomy group while for the cataract extraction group they were 23.1% and 15.4%; the difference was statistically significant (P < 0.05). The results suggest that primary posterior capsulorhexis with anterior vitrectomy in pediatric cataract surgery who are between 2 and 5 years old is necessary and effective procedure with low PCO rate.
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Affiliation(s)
- Yi Luo
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
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Wilson ME, Trivedi RH, Buckley EG, Granet DB, Lambert SR, Plager DA, Sinskey RM, Vasavada AR. ASCRS white paper. Hydrophobic acrylic intraocular lenses in children. J Cataract Refract Surg 2007; 33:1966-73. [PMID: 17964406 DOI: 10.1016/j.jcrs.2007.06.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 05/08/2007] [Indexed: 10/22/2022]
Affiliation(s)
- M Edward Wilson
- MUSC--Storm Eye Institute, 167 Ashley Avenue, Charleston, South Carolina 29425-5536, USA.
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Tassignon MJ, De Veuster I, Godts D, Kosec D, Van den Dooren K, Gobin L. Bag-in-the-lens intraocular lens implantation in the pediatric eye. J Cataract Refract Surg 2007; 33:611-7. [PMID: 17397732 DOI: 10.1016/j.jcrs.2006.12.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 12/19/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the efficacy, safety, and feasibility of implantation of a bag-in-the-lens intraocular lens (IOL) in children and babies. SETTING Departments of Ophthalmology, University Hospital, Antwerp, Belgium, and the University Hospital, Ljubljana, Slovenia, and a private ophthalmology practice, Oudenaarde, Belgium. METHODS Thirty-four eyes of 22 children had implantation of a bag-in-the-lens IOL. The ages ranged from 2 months to 14 years. Congenital cataract was present in 26 eyes, and persistent fetal vasculature (PFV) was concomitantly present in 4 eyes. Fifteen patients had bilateral cataract, and 6 had unilateral cataract. RESULTS In 3 eyes, the IOL could not be properly implanted. In these cases, secondary intervention was necessary because of early posterior capsule opacification. The mean postoperative follow-up was 17.45 months +/- 17.12 (SD) (range 4 to 68 months). None of the children except those presenting with PFV had anterior vitrectomy during surgery. The optical axis remained clear during the follow-up in all patients who had successful IOL implantation. CONCLUSIONS The bag-in-the-lens implantation technique in children and babies was safe and kept the visual axis clear after cataract surgery. In the near future, 4.0 or 4.5 mm IOLs will be available that may improve the success rate of IOL implantation in the small eyes of babies.
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De Groot V, Leysen I, Neuhann T, Gobin L, Tassignon MJ. One-year follow-up of bag-in-the-lens intraocular lens implantation in 60 eyes. J Cataract Refract Surg 2006; 32:1632-7. [PMID: 17010859 DOI: 10.1016/j.jcrs.2006.05.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 05/21/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE To report the feasibility and clinical results of implanting a bag-in-the-lens intraocular lens (IOL) designed to prevent posterior capsule opacification after cataract surgery. SETTING Departments of Ophthalmology, University of Antwerp, Antwerp, Belgium, and University of Munich, Munich, Germany. METHODS This prospective study comprised 63 eyes (55 patients; 7 children, 48 adults) scheduled for cataract surgery and bag-in-the-lens IOL implantation. A posterior curvilinear capsulorhexis the same size as the anterior capsulorhexis was created for IOL insertion. After surgery, lens epithelial cell (LEC) proliferation was documented every 6 months with a minimum follow-up of 12 months. RESULTS Sixty of 63 eyes (95%) had implantation of the bag-in-the-lens IOL. Conversion to a conventional IOL was necessary in 2 cases. In 1 eye, postoperative luxation of the IOL into the vitreous occurred as a result of an oversized anterior and posterior capsulorhexis. Three eyes had early postoperative iris incarceration in the lens groove that required surgery. No LEC proliferation on the optic occurred during a mean follow-up of 22.7 months (range 12 to 64 months); LEC proliferation was confined to the peripheral capsular bag. CONCLUSION Lens epithelial cell proliferation was mild and confined to the periphery of the capsular bag during follow-up, and the bag-in-the-lens IOL optic remained clear.
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Affiliation(s)
- Veva De Groot
- Department of Ophthalmology, University of Antwerp, Edegem, Belgium.
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Nihalani BR, Vasavada AR. Single-piece AcrySof intraocular lens implantation in children with congenital and developmental cataract. J Cataract Refract Surg 2006; 32:1527-34. [PMID: 16931267 DOI: 10.1016/j.jcrs.2006.04.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 04/20/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate surgical outcomes of 1-piece AcrySof SA30AL intraocular lens (IOL) (Alcon Laboratories) implantation in children having surgery for congenital and developmental cataracts. SETTING Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India. METHODS This prospective observational study comprised 134 consecutive eyes of 84 children from 2 to 15 years old who had surgery for congenital and developmental cataract. Two groups were formed depending on the age of the child at surgery. Primary posterior continuous curvilinear capsulorhexis (PCCC) was performed in children younger than 6 years (Group 1, 66 eyes), and no PCCC was performed in children older than 6 years (Group 2, 68 eyes). Vitrectomy was not performed. An AcrySof IOL was implanted in the bag in all eyes except 1 in Group 1, which received a sulcus-fixated IOL. The study's primary outcome measures were the incidence of visual axis obscuration and the need for a secondary procedure to clear the axis. Secondary observations included the incidence of posterior synechias, cell deposits, and haptic compression. A test of proportion was applied to determine whether age was a risk factor for the development of visual axis obscuration. RESULTS The mean age at surgery was 6.0 years +/- 3.2 (SD). The mean follow-up was 2.6 +/- 0.6 years. In Group 1, 20 eyes (30.3%) developed visual axis obscuration but only 6 (9.1%) required a secondary procedure. In Group 2, 20 eyes (29.4%) developed visual axis obscuration and 10 (14.7%) required secondary procedures. Posterior synechias were observed in 2 eyes (3.0%) in Group 1 and none in Group 2. Cell deposits were seen in 8 eyes (12.1%) in Group 1 and 8 eyes (11.8%) in Group 2. Haptic compression was noted in 1 eye in Group 2. Mild IOL decentration was observed in the 1 eye with a sulcus-fixated IOL. CONCLUSION The 1-piece AcrySof IOL provided satisfactory visual axis clarity, produced an acceptable inflammatory response, and maintained centration in pediatric eyes.
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Affiliation(s)
- Bharti R Nihalani
- Iladevi Cataract and IOL Research Centre, Raghudeep Eye Clinic, Gurukul Road, Memnagar, Ahmedabad, India
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Yuen C, Williams R, Batterbury M, Grierson I. Modification of the surface properties of a lens material to influence posterior capsular opacification. Clin Exp Ophthalmol 2006; 34:568-74. [PMID: 16925705 DOI: 10.1111/j.1442-9071.2006.01278.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the effect of surface properties of materials on cellular behaviour and the formation of posterior capsular opacification (PCO). METHODS Polymethylmethacrylate, silicone and a hydrophobic acrylic were plasma treated and used in tissue culture. The changes in surface properties were quantified by dynamic contact angle measurements. Bovine lens epithelial cells (BLECs) were seeded onto these materials and cultured for 1 month. Serial photographs were taken. The cells were then fixed and stained to facilitate counting. RESULTS Plasma treatment significantly increased the hydrophilicity of surfaces. BLECs grew on all surfaces but significantly more cells adhered to the treated than the untreated surfaces. On the untreated surfaces the BLECs had a fibroblastic morphology whereas on the treated surfaces the cells maintained their epithelial morphology. CONCLUSIONS Posterior capsular opacification is a form of wound healing and the behaviour of lens epithelial cells is central to its progression. Emphasis has been on the elimination of residual lens epithelial cells to combat PCO. This study demonstrated that the phenotype of BLECs was influenced by the surface properties of the intraocular lens materials. Gas plasma treatment of the materials increased their hydrophilicity and allowed the adhered BLECs to maintain their normal epithelial morphology. We believe that controlled growth of lens epithelial cells may reduce the incidence of PCO.
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Affiliation(s)
- Conrad Yuen
- Ophthalmology, University Clinical Department, School of Clinical Sciences, University of Liverpool, Liverpool, UK.
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Dholakia SA, Praveen MR, Vasavada AR, Nihalani B. Completion rate of primary posterior continuous curvilinear capsulorhexis and vitreous disturbance during congenital cataract surgery. J AAPOS 2006; 10:351-6. [PMID: 16935237 DOI: 10.1016/j.jaapos.2006.01.212] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Revised: 01/06/2006] [Accepted: 01/06/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE We sought to document the completion rate of primary posterior continuous curvilinear capsulorhexis during congenital cataract surgery and determine the incidence of disruption of vitreous face during this procedure. METHODS One hundred six consecutive eyes of patients undergoing posterior continuous curvilinear capsulorhexis (PCCC) during congenital cataract surgery were evaluated prospectively for completion of PCCC and disruption of vitreous face. PCCC was performed under high-viscosity sodium hyaluronate (Healon GV 1.4%) initiated with 26 g of cystotome and later completed with Kraff-Uttrata forceps by frequent grasping and regrasping of the flap. Completion of PCCC and disruption of vitreous face during the procedure was noted. Even in cases of disrupted vitreous face, PCCC was performed and completed with forceps and, later, disruption of vitreous face was managed with 2-port automated limbal anterior vitrectomy. The size of PCCC was measured. An Alcon AcrySof SA30AL was implanted in-the-bag if the PCCC was 4 mm or smaller and in the sulcus when the PCCC was larger than 4 mm. RESULTS The mean age of the 106 pediatric patients was 17 +/- 26 months (median, 6 months; range, 1 month to 8 years). PCCC was completed in all the eyes. Disruption of vitreous face during PCCC was noted in 5 of 106 (4.7%) eyes. The mean size of PCCC was 3.6 +/- 0.7 mm. A total of 98 (92.5%) had in-the-bag, and 8 (7.5%) eyes had sulcus implantation of IOL. CONCLUSION PCCC was completed in all eyes with minimal disruption of vitreous face in a well-controlled manner under high-viscosity viscoelastics.
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Affiliation(s)
- Sheena A Dholakia
- Iladevi Cataract and IOL Research Centre, Gurukul Road, Memnagar, Ahmedabad 380052, India
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Abstract
BACKGROUND Congenital cataracts are opacities of the lens in one or both eyes of children that cause a reduction in vision severe enough to require surgery. Cataract is the largest treatable cause of visual loss in childhood. Paediatric cataracts provide different challenges to those in adults. Intense inflammation, amblyopia and posterior capsule opacification can affect results of treatment. Two treatments commonly considered for congenital cataract are lensectomy and lens aspiration. OBJECTIVES The objective of this review was to assess the effects of surgical treatments for bilateral symmetrical congenital cataracts. Success was measured according to the vision attained and occurrence of adverse events. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, which contains the Cochrane Eyes and Vision Group Trials Register (2005, Issue 2), MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005, week 27), LILACS (6 July 2005), the Science Citation Index and the reference list of the included studies. We also contacted trial investigators and experts in the field for details of further studies. SELECTION CRITERIA We included all prospective, randomised controlled trials that compared one type of cataract surgery to another, or to no surgery, in children with bilateral congenital cataracts aged 15 years or younger. DATA COLLECTION AND ANALYSIS Two authors extracted data. No meta-analysis was performed. MAIN RESULTS Four trials met the inclusion criteria. All trials were concerned with reducing the development of visual axis opacification (VAO). This was achieved with techniques that included an anterior vitrectomy or optic capture. Posterior capsulotomy alone was inadequate except in older children. AUTHORS' CONCLUSIONS Evidence exists for the care of children with congenital or developmental bilateral cataracts to reduce the occurrence of visual axis opacification. Further randomised trials are required to inform modern practice about other concerns including the timing of surgery, age for implantation of an intraocular lens and development of long-term complications such as glaucoma and retinal detachment.
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Affiliation(s)
- V Long
- General Infirmary, Ophthalmology Department, Belmont Grove, Leeds, UK LS2 9NS.
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Yang ML, Hou CH, Lee JS, Liang YS, Kao LY, Lin KK. Clinical characteristics and surgical outcomes of pediatric cataract in Taiwan. Graefes Arch Clin Exp Ophthalmol 2006; 244:1485-90. [PMID: 16628419 DOI: 10.1007/s00417-006-0308-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 01/07/2006] [Accepted: 02/10/2006] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To report treatment of pediatric patients with cataract, and evaluate the efficiency of different surgical interventions. METHOD This study comprised a consecutive series of pediatric patients with congenital or developing cataract who received surgery between 1993 and 2002 at Chang Gung Memorial Hospital in Taiwan. Patients' demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. RESULTS Three hundred and ninety-nine eyes of 246 children were included; unilateral cataract was present 21.8% of the eyes. The age at surgery was ranged from 1 to 157 months. Eyes were grouped by surgical interventions performed: Group 1 included 98 eyes that had lensectomy. Group 2 included 89 eyes that had lensectomy and secondary intraocular lens implantation. Group 3 included 212 eyes that had lensectomy with primary intraocular implantation. The mean follow up time was 41.3 months. Finally, 23.1% group 1 patients, 42.1% group 2 patients, and 63.4% group 3 patients achieved visual acuity better than 20/60 (P=0.000). Upon analysis with multifactor regression, age at onset (P=0.011) was the only significant factor related to visual outcome. Complications such as after cataract and glaucoma occurred in 21.6% and 5.8% of all patients, respectively. CONCLUSIONS Intraocular lens implantation for children with congenital or developing cataract is an effective treatment for visual rehabilitation, even for those patients age 2 years and younger.
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Affiliation(s)
- Meng-Ling Yang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fu-Shing Street, Kweishan 333, Taoyuan, Taiwan, Republic of China
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Sharma N, Balasubramanya R, Dada VK, Vajpayee RB. Efficacy of trypan blue in posterior capsulorhexis with optic capture in pediatric cataracts [ISRCTN48221688]. BMC Ophthalmol 2006; 6:12. [PMID: 16539738 PMCID: PMC1434781 DOI: 10.1186/1471-2415-6-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2004] [Accepted: 03/16/2006] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the efficacy of trypan blue (0.06%) in posterior capsulorhexis with optic capture in pediatric cataracts. Methods In this prospective randomized controlled study, trypan blue dye assisted posterior capsulorhexis with optic capture was performed in 18 eyes (group 1) and no dye was used for posterior capsulorhexis (group 2) in 17 eyes. Results The mean size of the posterior capsulorhexis was 4.6 +/-1.77 mm and 4.0 +/- 0.93 mm in the group 1 and 2 respectively. Optic capture was possible in 17 eyes in the group 1 and 11 eyes in the group 2. Conclusion Trypan blue facilitates posterior capsulorhexis with optic capture of AcrySof IOL in cases of pediatric cataracts.
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Affiliation(s)
- Namrata Sharma
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, INDIA
| | - Ramamurthy Balasubramanya
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, INDIA
| | - Vijay K Dada
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, INDIA
| | - Rasik B Vajpayee
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, INDIA
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