1
|
Fernandez TA, Carr EW, Hajrasouliha AR. Cataract Formation Following Pars Plana Vitrectomy in the Pediatric Population. J Pediatr Ophthalmol Strabismus 2023; 60:421-426. [PMID: 36803244 DOI: 10.3928/01913913-20230118-01] [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 analyze post-vitrectomy cataract formation in the pediatric population to elucidate the number of phakic children requiring cataract surgery following vitreous surgery and the perioperative factors affecting cataract development in these patients. METHODS Eyes of pediatric patients that underwent phakic pars plana vitrectomy (PPV) with no prior cataract in a 10-year period were included. Analyses evaluated relationships between patient age and time to cataract surgery, as well as contributing factors for cataract formation. Final visual outcomes were also examined. Outcomes were collected for patient age at first vitrectomy, indication for vitrectomy, use of tamponade agents, history of ocular trauma, cataract status, and time to cataract surgery from first vitrectomy. RESULTS Of 44 eyes analyzed, 27 (61%) were noted to have some degree of cataract formation. Of these, 15 (56%; 34% of total eyes) underwent cataract surgery. Use of octafluoropropane (P = .04) or silicone oil (P = .03) positively correlated with the need for cataract surgery in the total study group. Patients requiring cataract surgery had worse endpoint visual acuities than those who did not undergo surgery (P = .02), although this difference becomes less significant in follow-up over 2 years (P = .30). Patients who had cataracts but did not need cataract surgery showed an improvement in visual acuity (P = .04), but this was not demonstrated in patients who did need cataract surgery (P = .90). CONCLUSIONS Pediatric eye care providers should be aware of the significant risk of cataract formation following a phakic PPV. [J Pediatr Ophthalmol Strabismus. 2023;60(6):421-426.].
Collapse
|
2
|
Chan HW, Van den Broeck F, Cools A, Walraedt S, Joniau I, Verdin H, Balikova I, Van Nuffel S, Delbeke P, De Baere E, Leroy BP, Nerinckx F. Paediatric cataract surgery with 27G vitrectomy instrumentation: the Ghent University Hospital Experience. Front Med (Lausanne) 2023; 10:1197984. [PMID: 37601772 PMCID: PMC10435324 DOI: 10.3389/fmed.2023.1197984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Objective To describe a cohort of paediatric patients who underwent unilateral or bilateral lens extractions at Ghent University hospital using the Dutch Ophthalmic Research Center (D.O.R.C.) ultra-short 27G vitrectomy system. Methods Retrospective analysis of the medical and surgical records of all children that underwent lens extraction between September 2016 and September 2020 using the D.O.R.C. ultra-short 27G vitrectomy system. Results Seventy-two eyes of 52 patients were included. The most important aetiologies in this study were of secondary (25.5%), developmental (13.7%), or genetic (13.7%) nature. No definitive cause could be established in more than a quarter of cases (27.5%) despite extensive work-up, them being deemed idiopathic. The remainder of cases (19.6%) was not assigned a final aetiologic designation at the time of the study due to contradicting or missing diagnostic data. This study could not identify any cataract cases related to infection or trauma. Surgical complications rate was 61.1% of which posterior capsule opacification was the most frequent with a rate of 25%. A significant short-term postoperative best-corrected visual acuity gain (≤ -0.2 LogMAR) was observed in 60.5% of eyes for which usable acuity data were available (n = 38). Conclusion Many different instruments and techniques have been described and used in the context of paediatric lens extractions, each with its advantages and disadvantages. This study illustrates that an ultra-short 27G vitrectomy system can be used to perform paediatric lens extractions with good surgical outcomes. Further studies and comparative trials are needed to ascertain this further.
Collapse
Affiliation(s)
- Hwei Wuen Chan
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
- Department of Ophthalmology, National University Singapore, Singapore, Singapore
| | - Filip Van den Broeck
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Axelle Cools
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Sophie Walraedt
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Inge Joniau
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Hannah Verdin
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Irina Balikova
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Elfride De Baere
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Bart P. Leroy
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium
- Division of Ophthalmology, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Fanny Nerinckx
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
3
|
Kalambe AS, Sano I, Sugihara K, Ishida A, Ichioka S, Shimada A, Tanito M. Intra-operative challenges encountered using the zepto nano-pulse precision capsulotomy device. Am J Ophthalmol Case Rep 2023; 30:101841. [PMID: 37077294 PMCID: PMC10106479 DOI: 10.1016/j.ajoc.2023.101841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose The Zepto nano-pulse precision capsulotomy is a novel device for capsulorhexis formation during cataract surgery. Few complications or challenges have been reported while using this device. The purpose of this paper is to highlight two intra-operative challenges that were encountered while using the Zepto device. Observations CASE 1 - A 65-year-old with advanced primary open angle glaucoma (POAG) and an in situ Ahmed Glaucoma Valve located in the anterior chamber. During a planned phacoemulsification procedure, the tube became trapped between the suction cup of the Zepto device and the lens, resulting in a sudden complete collapse of the anterior chamber. The procedure was completed after appropriate interventions. On post-operative day 1 Descemet folds were visible, and corneal endothelial cell density was reduced from 2101 cells/cm2 preoperatively to 1355 cells/cm2 at 19 months postoperatively. CASE 2 - A 66-year-old female with secondary cataract from chronic inflammation post trabeculectomy for advanced POAG. During a planned phacoemulsification procedure, despite synechialysis for the 360° posterior synechiae, the iris tissue was sucked into the suction cup of the Zepto device and became incarcerated over the lens. The procedure was completed after a successful intervention. Conclusions and importance Although not previously reported and possibly rare, intra-operative complications may be encountered while using the Zepto device, particularly in complex cataract cases. For the patient's safety and satisfactory post-operative and refractive outcomes, caution must be applied.
Collapse
|
4
|
Muacevic A, Adler JR. The Prevalence of Cataract in Children. Cureus 2022; 14:e30135. [PMID: 36381901 PMCID: PMC9645413 DOI: 10.7759/cureus.30135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Cataract is the leading cause of childhood blindness in developing countries. Early detection and treatment of childhood cataracts can reduce the burden of blindness in the nation. Often the etiology of pediatric cataract is idiopathic; however, genetics play a role in the development of congenital cataract. According to epidemiologists, one-fourth of cases of congenital cataracts are hereditary. Gene responsible for the development of cataract is identified using gene mapping, which helps to prevent future blindness in the family. Cataracts can also present with systemic disease, microphthalmia, microcornea, and aniridia. The presentation of cataracts varies in individuals, some are symptomatic while others are asymptomatic. Parents after noticing strabismus and leukocoria bring their children to an ophthalmologist. Early diagnosis can restore visual function in cases of congenital cataract. In young babies, the type of cataract is determined using slit-lamp examination and examination under anesthesia in OR. Most cases of pediatric cataracts are accidental findings during routine checkups. On direct ophthalmoscopy, red reflex is not appreciated in cases of cataracts. Advancing technology changes the ophthalmologist's approach to pediatric cataract surgery, improving postoperative refractory function. In children, minor incision surgery was preferred to heal early. An appropriate choice of intraocular lens (IOL) should be made for implantation in a child's eye to avoid postimplanted complications. Inflammation and amblyopia affect the outcome of treatment. Complications of cataract surgery include posterior capsule opacification, glaucoma, inflammation, and uveitis.
Collapse
|
5
|
Kavitha V, Heralgi MM, Aafreen S. Analysis of postoperative visual and surgical outcome following surgery for absorbed cataract in pediatric age group and the intraoperative difficulties. Indian J Ophthalmol 2022; 70:788-793. [PMID: 35225515 PMCID: PMC9114569 DOI: 10.4103/ijo.ijo_1091_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- V Kavitha
- Department of Paediatric Ophthalmology, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Mallikarjun M Heralgi
- Department of Paediatric Ophthalmology, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Saba Aafreen
- Department of Paediatric Ophthalmology, Sankara Eye Hospital, Shimoga, Karnataka, India
| |
Collapse
|
6
|
Panahibazaz MR, Mohammadpour S, Samaeili A. Overcoming myopic shift by the initial inductive hypermetropia in pediatric cataract surgery. Indian J Ophthalmol 2021; 69:3515-3519. [PMID: 34826986 PMCID: PMC8837308 DOI: 10.4103/ijo.ijo_494_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: To assess the outcome of under-correction of intraocular lens (IOL) power in pediatric cataract surgery. Methods: We collected clinical data of 103 patients (181 eyes), all aged ≤15 years, who had undergone cataract surgery by a surgeon during 2006–2016. The mean duration of follow-up was 73 ± 38 months (range: 24–108). IOL power was calculated by Hoffer Q formula in axial length (AL) <21 mm and SRKT formula in AL ≥21 mm and then modified based on this approach: 7D initial inductive hypermetropization in children ≤1-year-old, 5D in 1–3, 3.5D in 3–5, 2.5D in 5–7, 1.5D in 7–9, 1D in 9–10, and 0 in children >10 years old. Results: The mean age of all children at surgery time was 5.85 ± 4.56 years (range: 1–178 months). There was a mean myopic shift of −6.379 D in the ≤1 year, −5.532 in the 1–3, −3.194 in the 3–5, −2.301 in the 5–7, −1.06 in the 7–9, −1.567 in the 9–10, and 0.114 in the >10-year-old age group. In 125 eyes (69.1%) of 181, the final SE was between −2 and +2 D, and 21 eyes (11.6%) achieved the goal of emmetropization. Mean best-corrected visual acuity logarithm of the minimum angle of the resolution was 0.30 in children ≤1 year, 0.39 in 1–3, 0.21 in 3–5, 0.18 in 5–7, 0.14 in 7–9, 0.16 in 9–10, and 0.11 in children >10 years old. Conclusion: This study shows a larger myopic shift in younger children. Using our approach, all age groups could finally achieve acceptable final refraction.
Collapse
Affiliation(s)
- Mahmoud Reza Panahibazaz
- Department of Ophthalmology, Faculty of Medicine, Ahwaz Jundishapur University of Medical Science; Infectious Ophthalmologic Research Center, Imam Khomeiny Hospital Research and Development Unit, Ahwaz Jundishapur University of Medical Science, Ahwaz, Iran
| | - Shirin Mohammadpour
- Department of Ophthalmology, Faculty of Medicine, Ahwaz Jundishapur University of Medical Science; Infectious Ophthalmologic Research Center, Imam Khomeiny Hospital Research and Development Unit, Ahwaz Jundishapur University of Medical Science, Ahwaz, Iran
| | - Azade Samaeili
- Department of Ophthalmology, Faculty of Medicine, Ahwaz Jundishapur University of Medical Science; Infectious Ophthalmologic Research Center, Imam Khomeiny Hospital Research and Development Unit, Ahwaz Jundishapur University of Medical Science, Ahwaz, Iran
| |
Collapse
|
7
|
Zhang JS, Wang JD, Yusufu M, Cao K, Jin SS, Xiong Y, Li J, Sun XL, Chen SY, Liu ZY, Fu J, Li L, You QS, Wan XH. The effect of retaining intact posterior capsule in congenital cataract surgery in children aged 4-8 years. BMC Ophthalmol 2021; 21:332. [PMID: 34511057 PMCID: PMC8436493 DOI: 10.1186/s12886-021-02098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background The present study sought to observe the effect of retaining intact posterior capsule in congenital cataract surgery in children aged 4–8 years. Methods This is a retrospective case control study. Seventy-seven children (130 eyes) aged from 4 to 8 years who underwent cataract surgery were divided into two groups. In Group A, 50 eyes underwent phacoemulsification, intraocular lens implantation and posterior capsule capsulotomy combined with anterior vitrectomy. In Group B, 80 eyes underwent cataract phacoemulsification and intraocular lens implantation. The postoperative visual acuity and the rate of complications were compared. Results In all patients, cataract surgeries were performed evenly without intraoperative complications. The follow-up time ranged from 6 months to 42 months. No apparent visual axis opacity was detected in group A during the follow-up. By the last visit, apparent visual axis opacity was detected in 31 eyes (38.75%) in group B. Among them, 9 eyes (29.03%) with mild posterior capsule opacification (PCO) were treated with Nd:YAG laser, 3 eyes (9.68%) with thick proliferative membranes were treated with posterior capsule capsulotomy combined with anterior vitrectomy and proliferative membranes in 19 eyes (61.29%) were completely aspired and the posterior capsule was retained. During follow-up, only 2 (6.45%) eyes had PCO recurrence and were treated with Nd:YAG laser. The visual acuity was significantly higher than that before surgery in all patients. Conclusions For older children, the incidence of PCO will be low even if intact posterior capsule is retained. Either Nd:YAG laser or surgical treatment for PCO will be able to maintain good vision.
Collapse
Affiliation(s)
- Jing Shang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Jin Da Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Shan Shan Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Ying Xiong
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, 100005, China
| | - Jing Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, 100005, China
| | - Xiu Li Sun
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Shu Ying Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Zhen Yu Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, 100005, China
| | - Li Li
- National Key Discipline of Pediatrics, Ministry of Education, Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Qi Sheng You
- Casey Eye Institute, Oregon Health Science University, Oregon, USA
| | - Xiu Hua Wan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, 100005, China.
| |
Collapse
|
8
|
Kim JD, Kang HG, Kim TY, Lee J, Kim M. Lateral Decubitus Position for Pediatric Nd:YAG Laser Capsulotomy under General Anesthesia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.7.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To report a successful case of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy performed in a noncompliant pediatric patient using the lateral decubitus position and a conventional slit-lamp-based laser system under general anesthesia.Case summary: Progression of a thick posterior capsular opacity with associated vision loss (best-correct visual acuity of 0.1) was detected in a nine-year-old child with a past history of cataract surgery in his right eye. Diagnosed with pediatric uveitis at the age of five, he had been treated previously using a combination of topical and systemic corticosteroids, which led to the development of the cataract and subsequent surgery 16 months later. Severe photophobia prevented outpatient-based laser treatment, and the patient underwent our modified procedure. Under general anesthesia, the patient was placed in a lateral decubitus position with the use of a long intubation tube. The height of the bed and table-based laser system was adjusted so as to minimize strain when positioning the child’s head. Successful laser capsulotomy was performed within 10 minutes, and the entire anesthesia time was less than 30 minutes. The patient experienced immediate improvement in symptoms, showing a visual acuity of 1.0, which has been sustained as of his most recent visit, 3 months postoperatively. The patient experienced no ocular or anesthesia- related complications. Conclusions: Nd:YAG laser capsulotomy performed by careful positioning (lateral decubitus) under general anesthesia is a viable strategy for the safe and efficient removal of posterior capsular opacities in children with poor compliance.
Collapse
|
9
|
Sen P, Chandra K, Jain E, Sen A, Kumar A, Mohan A, Shah C. Audit of 1000 consecutive cases of sutureless cataract surgery in children above two years of age. Indian J Ophthalmol 2021; 68:460-465. [PMID: 32057003 PMCID: PMC7043184 DOI: 10.4103/ijo.ijo_1138_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.
Collapse
Affiliation(s)
- Pradhnya Sen
- Children Eye Care Center, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Kriti Chandra
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Elesh Jain
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Alok Sen
- Department of Retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Amit Kumar
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Amit Mohan
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Chintan Shah
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| |
Collapse
|
10
|
Manisha S, Sunita M, Sanjeev M, Ravi K, Aarzoo J, Ajai A. Anatomical and Clinical Characteristics of Paediatric and Adult Eyes. NATIONAL JOURNAL OF CLINICAL ANATOMY 2021. [DOI: 10.4103/njca.njca_16_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
11
|
Oleshchenko I, Cok OY, Iureva T, Zabolotskii D, Kripak A. Effect of pterygopalatine blockade on perioperative stress and inflammatory outcomes following paediatric cataract surgery. Reg Anesth Pain Med 2020; 45:204-208. [PMID: 31964855 DOI: 10.1136/rapm-2019-100823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/15/2019] [Accepted: 12/29/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND General anesthesia is required to perform pediatric cataract surgery. To reduce severity of surgical intervention and postoperative complications, regional techniques have been concomitantly used. The traditional regional ophthalmic techniques are retrobulbar, peribulbar and sub-Tenon blocks, which present some technical difficulties and associated complication risks. The pterygopalatine blockade has been exempt of many of these concerns as it is performed out of the orbit. The purpose of this study was to compare the analgesic and anti-inflammatory effects of the pterygopalatine blockade with retrobulbar block in children undergoing elective congenital cataract surgery. METHODS After approval of ethics committee and informed consents, patients were enrolled to the study to have either ultrasound-guided pterygopalatine block (group P) or retrobulbar block (group R), with 2 mL lidocaine 2% and 1 mL ropivacaine 0.5%. Hemodynamic monitoring was recorded throughout the perioperative period. Cortisol level and oxidation-reduction status were assessed before and after surgery. Pain and inflammatory response (Tyndall effect, corneal syndrome and edema) were assessed on the first postoperative day. RESULTS Comparative analysis demonstrated a decrease in cortisol of 123.24% (p˂0.05) and an increase in the redox coefficient of 37.7% (p˂0.05) in group P. Pain intensity was significantly higher in group R until the 16th postoperative hour. The corneal syndrome in patients in group P and group R was noted by 7.6% and in 32.1%, respectively (p˂0.05). CONCLUSION The use of the pterygopalatine blockade as a component of anesthesia in pediatric cataract surgery allows reduction of the severity of surgical stress during surgical intervention, providing intraoperative hemodynamic stability and prolonged analgesia.
Collapse
Affiliation(s)
- Irina Oleshchenko
- Anesthesiology, Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
| | - Oya Yalcin Cok
- Department of Anesthesiology, Baskent University, Ankara, Ankara, Turkey
| | - Tatiana Iureva
- Anesthesiology, Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
| | - Dmitrii Zabolotskii
- Anesthesiology and Reanimation, and Intensive Pediatric Care, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation
| | - Anna Kripak
- Anesthesiology, Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
| |
Collapse
|
12
|
Kosmala J, Grabska-Liberek I, Stanislovas Ašoklis R. Recommendations for ultrasound examination in ophthalmology. Part I: Ultrabiomicroscopic examination. J Ultrason 2019; 18:344-348. [PMID: 30763020 PMCID: PMC6444308 DOI: 10.15557/jou.2018.0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2018] [Indexed: 12/29/2022] Open
Abstract
Range of ultrasounds used in medical imaging is between 2 and 80 MHz. The highest frequencies are applied in medical imaging of an anterior segment of an eyeball. This paper covers the newest method of ultrasound imaging - an ultrabiomicroscopic examination. Its name reflects resolution which has so far been unavailable, and which allows for imaging a structure of the examined tissues. The article includes basic information about the structure and principles of operation of ultrabiomicroscopic examination tools. Moreover, its position among other methods for echographic examination of an eyeball was determined. Examination techniques and the role of standards of conduct at each stage of a diagnostic procedure were discussed. A role of insufficient cooperation between constructors of new ultrasonographic diagnostic tools and software IT specialist with the users of these tools, which results in the lack of consistency between the components of these sets was emphasized. Based on long term experience in ultrabiomicroscopic examinations, the authors shared observations on practical aspects of this method. Finally, indications and contraindications for ultrabiomicroscopic diagnostics were listed. Introduction of an ultrahigh frequency ultrasound probe allowed for the visualization of an post-iridial area of an anterior segment of an eyeball - an area whose diagnosis is impossible with other diagnostic methods. A wide spectrum of diagnostic indications, which covers both diseases and development anomalies of an anterior segment of an eyeball, confirms a special meaning of this method. Range of ultrasounds used in medical imaging is between 2 and 80 MHz. The highest frequencies are applied in medical imaging of an anterior segment of an eyeball. This paper covers the newest method of ultrasound imaging – an ultrabiomicroscopic examination. Its name reflects resolution which has so far been unavailable, and which allows for imaging a structure of the examined tissues. The article includes basic information about the structure and principles of operation of ultrabiomicroscopic examination tools. Moreover, its position among other methods for echographic examination of an eyeball was determined. Examination techniques and the role of standards of conduct at each stage of a diagnostic procedure were discussed. A role of insufficient cooperation between constructors of new ultrasonographic diagnostic tools and software IT specialist with the users of these tools, which results in the lack of consistency between the components of these sets was emphasized. Based on long term experience in ultrabiomicroscopic examinations, the authors shared observations on practical aspects of this method. Finally, indications and contraindications for ultrabiomicroscopic diagnostics were listed. Introduction of an ultrahigh frequency ultrasound probe allowed for the visualization of an post-iridial area of an anterior segment of an eyeball – an area whose diagnosis is impossible with other diagnostic methods. A wide spectrum of diagnostic indications, which covers both diseases and development anomalies of an anterior segment of an eyeball, confirms a special meaning of this method.
Collapse
Affiliation(s)
- Jacek Kosmala
- Department of Ophthalmology, Medical Centre of Postgraduate Education, Professor Witold Orlowski Independent Public Clinical Hospital , Warsaw , Poland
| | - Iwona Grabska-Liberek
- Department of Ophthalmology, Medical Centre of Postgraduate Education, Professor Witold Orlowski Independent Public Clinical Hospital , Warsaw , Poland
| | - Rimvydas Stanislovas Ašoklis
- Vilnius University, Faculty of Medicine , Vilnius , Lithuania ; Center of Eye Diseases in Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
| |
Collapse
|
13
|
Xie YB, Ren MY, Wang Q, Wang LH. Intraocular lens optic capture in pediatric cataract surgery. Int J Ophthalmol 2018; 11:1403-1410. [PMID: 30140648 DOI: 10.18240/ijo.2018.08.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/27/2018] [Indexed: 12/28/2022] Open
Abstract
Posterior capsule opacification (PCO) remains the most common complication of pediatric cataract surgery despite continuous efforts to reduce its incidence. For this reason, pediatric cataract surgeons have expended considerable effort into preventing and mitigating PCO. The intraocular lens (IOL) optic capture technique has been used for the prevention of PCO after pediatric cataract surgery for more than 20y, but there is still no professional consensus. However, recent research has shown encouraging results. The IOL optic capture technique can be performed without anterior vitrectomy to prevent PCO, even in younger children. The type and characteristics of IOLs used for optic capture technique, the location of IOL and the complications of IOL optic capture in children are here reviewed.
Collapse
Affiliation(s)
- Ying-Bin Xie
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Mei-Yu Ren
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Qi Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Li-Hua Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| |
Collapse
|
14
|
Šimunović M, Paradžik M, Škrabić R, Unić I, Bućan K, Škrabić V. Cataract as Early Ocular Complication in Children and Adolescents with Type 1 Diabetes Mellitus. Int J Endocrinol 2018; 2018:6763586. [PMID: 29755521 PMCID: PMC5883981 DOI: 10.1155/2018/6763586] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/28/2018] [Indexed: 12/19/2022] Open
Abstract
Cataract is a rare manifestation of ocular complication at an early phase of T1DM in the pediatric population. The pathophysiological mechanism of early diabetic cataract has not been fully understood; however, there are many theories about the possible etiology including osmotic damage, polyol pathway, and oxidative stress. The prevalence of early diabetic cataract in the population varies between 0.7 and 3.4% of children and adolescents with T1DM. The occurrence of diabetic cataract in most pediatric patients is the first sign of T1DM or occurs within 6 months of diagnosis of T1DM. Today, there are many experimental therapies for the treatment of diabetic cataract, but cataract surgery continues to be a gold standard in the treatment of diabetic cataract. Since the cataract is the leading cause of visual impairment in patients with T1DM, diabetic cataract requires an initial screening as well as continuous surveillance as a measure of prevention and this should be included in the guidelines of pediatric diabetes societies.
Collapse
Affiliation(s)
- Marko Šimunović
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Martina Paradžik
- Department of Ophthalmology, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Roko Škrabić
- School of Medicine, University of Split, Šoltanska 2, Split, Croatia
| | - Ivana Unić
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Kajo Bućan
- Department of Ophthalmology, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Veselin Škrabić
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| |
Collapse
|
15
|
Abstract
Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference.
Collapse
Affiliation(s)
| | - Ganesh Pillay
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Chirakshi Dhull
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Esha Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Manish Mahabir
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Pulak Aggarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| |
Collapse
|