Pars plicata lensectomy/vitrectomy for developmental cataract extraction: surgical results

Modification of the high-speed vitrectomy system TSV 25 for pediatric cataract surgery

Modifications of a transconjunctival sutureless vitrectomy system (TSV 25, Bausch & Lomb Surgical) for removing cataracts and performing poster capsulotomy-anterior vitrectomy in children are reported.

Posterior capsulorhexis with optic capture in pediatric cataract and intraocular lens surgery

BACKGROUND

A major concern in pediatric intraocular lens implantation surgery is the high incidence of posterior capsule opacification. The purpose of this article is to investigate a surgical technique for maintaining a clear visual axis after pediatric cataract and intraocular lens surgery.

METHODS

In a prospective evaluation, posterior capsulorhexis with optic capture as a surgical technique for preventing secondary membrane formation after pediatric cataract extraction is investigated. This technique involves capture of an intraocular lens optic through a posterior curvilinear capsulorhexis opening. Perioperative complications and incidence of secondary cataract are presented. Results will be compared to an historic cohort of patients with pediatric cataract-intraocular lens who did not have posterior continuous curvilinear capsulorhexis with optic capture.

RESULTS

In 13 consecutive eyes operated on in children aged 2 to 12 years (mean, 5.8 years), there was no opacification of the visual axis at a mean follow-up of 19 months after surgery (range, 8-30 years).

CONCLUSION

Posterior capsulorhexis with optic capture holds promise as a technique for preventing secondary membrane formation. This maneuver ensures centration of the posterior chamber intraocular lens while eliminating the need for an anterior vitrectomy. Apposition of the anterior and posterior capsule leaflets anterior to the optic may limit the migration of Elschnig pearls, reducing the incidence of secondary membranes and the need for additional procedures.

Infantile cataracts

Cataracts are one of the most treatable causes of visual impairment during infancy. Recent epidemiological studies have shown that they have a prevalence of 1.2 to 6.0 cases per 10,000 infants. The morphology of infantile cataracts can be helpful in establishing their etiology and prognosis. Early surgery and optical correction have resulted in an improved outcome for infants with either unilateral or bilateral cataracts. While contact lenses continue to be the standard means of optically correcting an infant's eyes after cataract surgery, intraocular lenses are gaining in popularity as an alternative means of optically correcting these eyes. Post-operative complications occur more commonly after infantile than adult cataract surgery and many of these complications do not develop until years later. As a result, it is critical that children be followed closely on a long term basis after infantile cataract surgery.

Factors affecting visual outcome after surgery for bilateral congenital cataracts

The medical records of 33 patients with dense bilateral congenital cataracts were analyzed for factors affecting visual outcome. The average postoperative follow-up was 6.3 years. Of the 23 patients tested with optotypes (verbal children), 14 had visual acuities of 20/80 or better. Eight patients had binocular vision. Preoperative nystagmus, age at surgery, microphthalmos, and postoperative strabismus were not prognostically significant in visual outcome. Postoperative nystagmus was common and was not indicative of a poor visual outcome. Ocular anomalies, systemic anomalies, and postoperative complications were associated with a lower percentage of good postoperative visual acuities.

Long-term visual results and complications in children with aphakia. A function of cataract type

PURPOSE

Previous studies of outcome in children with aphakia have approached the data by grouping patients according to features such as age at surgery, type of procedure, or some other common attribute. The purpose of this study is to identify factors predictive for visual outcome and complications in pediatric patients with cataracts.

METHOD

One hundred seventy-four eyes in 118 patients underwent lensectomy and anterior vitrectomy for congenital or juvenile cataracts. All received early optical correction, occlusion therapy when necessary, and follow-up for at least 6 months. Visual outcome and complications were analyzed statistically to determine predictive factors. Features analyzed included cataract type, laterality, age at onset, follow-up, and corneal size.

RESULTS

Statistical analysis showed that the most important predictor of long-term visual outcome and complications is cataract type. Visual outcome differed significantly by cataract type, with best results in the lamellar and posterior lentiglobus groups. Unilateral cases had a mean acuity lower than bilateral cases. Other factors, such as age at surgery and corneal size, were less predictive but closely linked to cataract type. Complications, such as aphakic glaucoma, also were more closely linked to the type of cataract than to other variables.

CONCLUSION

The results indicate that an important determinant of long-term outcome and complications in aphakic children is cataract type. Other features were found to be closely correlated to cataract type and were not independently significant.

Is the phakic eye normal in monocular pediatric aphakia?

This retrospective review of 97 pediatric patients who underwent monocular surgery for congenital or developmental cataracts studied the incidence of abnormalities in the contralateral phakic eye. Fifty-nine percent of patients had a normal phakic eye. However, 40 patients showed at least one abnormality in the phakic eye: reduced vision (21%), nystagmus (19%), cataract (15%), iris heterochromia (9%), myopia (6%), microphthalmos (6%), pupillary miosis (2%), congenital glaucoma (2%), optic nerve abnormality (2%), aniridia (1%), and corneal opacity (1%). Not all abnormalities were detected at the time of diagnosis of the contralateral cataract. The more significant findings of reduced vision and nystagmus in the phakic eye were usually detected postoperatively, often several months after the optimum time for treatment of pediatric cataracts. We suggest that monocular cataract surgery not be delayed. This will allow the best vision to be obtained for the aphakic eye, as the "sound eye" may not always be normal in monocular pediatric aphakia.