Pediatric cataract surgery with hydrophilic acrylic intraocular lens implantation in Nepalese children

Analysis of postoperative visual and surgical outcome following surgery for absorbed cataract in pediatric age group and the intraoperative difficulties

PURPOSE

To analyze the postoperative visual and surgical outcomes following surgery for pediatric-absorbed cataracts and intraoperative difficulties.

METHODS

This prospective longitudinal study included 43 eyes (30 children) with absorbed cataracts aged between 6 months and 18 years (either sex). All children underwent best-corrected visual acuity (BCVA), anterior and posterior segment evaluation, rubella titer estimation, intraocular lens (IOL) power calculation, superior small incision cataract surgery with or without posterior capsulotomy/anterior vitrectomy/IOL implantation under general anesthesia, visual rehabilitation, and were followed up for 1 year.

RESULTS

The mean age was 7.89 ± 4.84 years. Preoperative BCVA distance: 39 eyes had either perception of light (PL) or counting finger close to face (CFCF); near BCVA: all eyes had either PL or N36. Postoperative (12 months) distant BCVA: a majority of the eyes (27) had 6/60-1/60, 11 eyes had 6/18-6/36; near: N18 in 19 eyes, N6 in 7 eyes. Anterior continuous curvilinear capsulorrhexis (ACCC) was possible in eight eyes. Cortical aspiration was difficult in 16 eyes (peripheral calcified ring). A majority (32 eyes) underwent in the sulcus implantation (in-the-bag: eight eyes); two eyes: no IOL, one eye: secondary IOL. Eleven eyes had early postoperative inflammation. At 12 months, one eye underwent membranectomy for visual axis opacification and 38 eyes had well-centered IOLs.

CONCLUSION

Surgery in absorbed cataracts is challenging because of the anatomic disorganization of the absorbed lens. By adopting appropriate surgical methods and good visual rehabilitation, one can achieve satisfactory surgical and visual outcomes, highlighting the need for surgical intervention.

Limitations in cataract surgical services for children in Ethiopia: a nationwide survey of pediatric cataract surgeons

Background

Bilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia.

Methods

A Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children (0–5 years).

Results

All nine responded. All but one had received either 12- or 3–5-month’s training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. The surgeons were based in seven health facilities: five in the capital (Addis Ababa) and eight in six public referral hospitals and one private center.

Over 12 months (2017–2018) 508 children (592 eyes) aged 0–18 years (most < 15 years) were operated by these surgeons. 84 (17%) had bilateral cataract, and 424 (83%) had unilateral cataract mainly following trauma. A mean of 66 (range 18–145) eyes were operated per surgeon. Seventy-one additional children aged > 5 years were operated by other surgeons. There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country.

Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 h.

Conclusion

Despite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped pediatric ophthalmology teams are urgently required, with deployment to under-served areas.

Commentary review: challenges of intraocular lens implantation for congenital cataract infants

As an indispensable part of congenital cataract surgery, intraocular lens (IOL) implantation in infantile patients has long-term positive impacts on visual rehabilitation, as well as postoperative complications inevitably. Timing of IOL implantation in infantile congenital cataract patients is not simply a point-in-time but a personalized decision that comprehensively takes age at surgery, risks of postoperative complications, and economic condition of family in consideration, and combines with choosing suitable IOL type and power. For infants with well-developed eyeballs and good systemic conditions, IOL implantation at six months of age or older is safe and effective. Otherwise, secondary IOL implantation may be a safer choice.

Characterization of postoperative "fibrin web" formation after canine cataract surgery

PURPOSE

To describe the occurrence and associated factors for "fibrin web" (FW) formation following phacoemulsification in dogs.

METHODS

A retrospective review of medical records of all dogs undergoing phacoemulsification (MU-Veterinary Health Center, 2014-2018) was conducted to associate FW formation with signalment, systemic co-morbidities, cataract stage, surgeon (resident vs faculty), phacoemulsification time, IOL, and intracameral injections including viscoelastic type. Both univariate and multivariate statistical analyses were performed to evaluate associations among variables with FW formation.

RESULTS

Data from 398 eyes on 201 dogs were included; 4 left eyes (4 dogs) developed presumptive endophthalmitis and were excluded from further analysis. Forty-eight eyes did not have cataract surgery. Hence, 350 eyes on 201 dogs were included in the analyses. Among these, 84 eyes (59 dogs) developed a FW. Univariate analyses showed that the odds of FW increased with age and phacoemulsification time. Additionally, FW web was associated lens type, lens brand, and viscoelastic type. Multivariate analyses showed that when comparing lens types in combination with a particular viscoelastic, viscoelastic impacted the estimated prevalence of FW formation the most. In contrast, when the data were analyzed by lens brand, lens brand impacted prevalence more than viscoelastic type. Diabetes mellitus was not associated with FW formation.

CONCLUSIONS

Based on the available data, intraocular lens implantation, viscoelastic type, dog age, and phacoemulsification time were associated with FW formation. Diabetes mellitus, gender, cataract stage, surgeon, intracameral injections other than viscoeleastic, and intra- and postoperative complications were not associated with FW formation.

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

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.

Using Optical Coherence Tomography in the Management of Postoperative Wound Leaks After Cataract Surgery

Health care providers who participate in postoperative care of patients who have had cataract surgery should carefully evaluate for the presence of wound leak or wound gape as a potential complication.