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Background@#Pediatric cataract is one of the most common preventable cause of childhood blindness worldwide. Early and timely intervention of pediatric cataract is important to maximize the visual outcomes and start prompt visual rehabilitation.@*Objectives@#This study aimed to determine the average time from the day of initial consult at the outpatient clinic to the day of the cataract surgery and compare the effects of delayed surgery on visual outcomes of patients.@*Methods@#This is a retrospective chart review of medical records from January 2015 to June 2022. The dates of the different steps in the process up to the day of intervention were noted and the average interval duration and the total waiting time were determined. Patients operated on within 2 weeks from initial consult was defined as no delay while those operated >2 weeks had delayed surgery. Pre-operative and post-operative best corrected log MAR visual acuity were compared within each group to determine if delay in surgical intervention has a significant effect on the visual outcomes of patients.@*Results@#Median age at initial consult was 4.9 years while median age at surgery was 5.2 years. Ninety-nine (99) patients had developmental cataract and 123 patients had bilateral cataract. Leukocoria was the most common chief complaint (63.45%). Pre-operatively, 94 patients had strabismus, 49 had eye preference, 48 had nystagmus, and 43 had amblyopia in the diagnosis. There was significantly faster admission to cataract surgery during the pandemic compared to pre-pandemic period but there was no difference in the total waiting time. Patients with congenital cataract had the least total waiting time followed by developmental, and rubella cataract. There is no significant difference in visual outcomes between patients operated without delay and with delay.@*Conclusion@#There is delayed age at diagnosis and surgery of pediatric cataract patients in the Philippine General Hospital. Early surgery did not reflect better visual outcomes compared to delayed surgery probably due to delay in consultation of patients.
Subject(s)
CataractABSTRACT
Background: Following penetrating keratoplasty, cataract surgery warrants certain modifications to ensure maximum survival of the graft. Purpose: To emphasize the intraoperative challenges and surgical manipulations to be followed. Synopsis: The surgeon makes a superior sclerocorneal tunnel avoiding the graft host junction. Dispersive viscoelastic is used. Continuous curvilinear capsulorhexis is done. Cataractous lens aspirated with a low flow rate. The intraocular lens is placed in the bag. Superior peripheral iridectomy and primary posterior capsulorhexis are done. The wound closed with two interrupted 10�nylon sutures. Graft host junction integrity is maintained. Highlights: Ensure 1. Good intraoperative corneal visibility, 2. Avoid graft host junction for main port incision 3. Generous dispersive viscoelastic use/soft shell technique to protect the corneal endothelium, 4. Avoid phaco energy in case of soft cataracts/low phaco energy and flow rates, 5. Phaco probe to be meticulously oriented away from corneal endothelium, 6. Primary posterior capsulorhexis to be done as in any pediatric cataract surgery, 7. Make sure of the graft host junction integrity at the end of the surgery, 8. Restrict to a single port whenever possible.
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Background: A successful outcome in pediatric cataract surgery is determined by an intact, curvilinear anterior capsulotomy which is dependent on the type and density of cataract, the morphology of the anterior capsule, and associated anterior segment pathologies. Purpose: This video highlights 10 different techniques which can be used for capsulorhexis in pediatric cataract. Synopsis: The choice of technique for capsulorhexis in pediatric cataract is on case basis, namely the gold standard manual capsulotomy aided by rhexis forceps (1. Standard capsulorhexis/2. Vitrector, Vitrectorhexis), with an assistance from capsular staining (3. Blue?rhexis), or by coaxial illumination (4. Coaxial?rhexis) or by just the sheen of capsule (5. Sheen?rhexis). The anterior chamber can be maintained using ophthalmic visco?elastic device (Visco?rhexis) or by irrigation fluid (6. Hydro?rhexis). A speed?breaker in the routine capsulotomy is the presence of plaque which is managed by rhexis forceps (7. Plaque?rhexis) or by a vitrector (vitrectorhexis) or a pair of micro?scissors (8. Scissor rhexis). Above all, the technology of femto?second?laser?assisted (9. Femto?rhexis) and zepto?pulse?precision capsulotomy (10. Zepto?rhexis) is also illustrated. Highlights: This video highlights the 10 different techniques of capsulorhexis in pediatric cataract surgery
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This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.
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Purpose: To determine the morphology of pediatric cataracts and assess the status of the anterior and posterior capsules preoperatively on swept?source anterior segment optical coherence tomography (ASOCT) and compare the findings to those of intraoperative examination. Secondly, we aimed to obtain biometric measurements on ASOCT and compare them to those obtained on A?scan/optical methods. Methods: This was a prospective and observational study carried out at a tertiary care referral institute. ASOCT scans for anterior segment were obtained preoperatively for all patients, aged <8 years, scheduled for paediatric cataract surgery. The morphology of the lens and capsule and biometry were performed on ASOCT and the same were assessed intraoperatively. The main outcome measures were comparison of ASOCT findings to intraoperative findings. Results: The study included 33 eyes of 29 patients (range 3 months–8 years). The morphological characterization of cataract on ASOCT was accurate in 31/33 (94%) cases. ASOCT accurately identified fibrosis and rupture of the anterior and posterior capsules in 32/33 (97%) cases each. In 30% of eyes, ASOCT gave additional information preoperatively compared to the slit lamp. Intraclass correlation coefficient (ICC) calculation revealed a good agreement between the keratometry values obtained on ASOCT and those obtained preoperatively with a handheld/optical keratometer (ICC = 0.86, P = 0.001). Conclusion: ASOCT is a valuable tool that could provide complete preoperative information of the lens and capsule in pediatric cataract cases. In children as young as 3 months of age, intraoperative risks and surprises could be diminished. The keratometric readings are highly dependent on patient cooperation but show good agreement with the handheld/optical keratometer readings.
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Purpose: The aim of the study was to evaluate the outcomes of cataract surgery in patients of the pediatric age group with systemic comorbidities. Methods: Medical records of 54 eyes (30 patients) of the pediatric age group with systemic comorbidities who had undergone cataract surgery in a tertiary?care center were reviewed. The following parameters were recorded: systemic comorbidity; toxoplasmosis, rubella, cytomegalovirus, herpes simplex, HIV (TORCH) profile, best spectacle?corrected visual acuity (BSCVA), strabismus, nystagmus, and cataract morphology. Results: Thirty patients with a mean age of 55 months (9 months–14 years) were included. On average, every child was seen by three physicians, and the mean duration between the first visit to a physician and presentation to our center was 2.23 ± 0.67 years. The various causes for delay in referral include multiple referrals due to a lack of general anesthesia services in 78% of cases, a long waiting list at the referral hospital in 35% of cases, and a lack of awareness at the primary?care physician level in 50% of cases. The mean BSCVA at presentation was 1.4 logMAR (0.3 to 3 logMAR). The most common cataract morphology was that of zonular cataract (31.48%; 17/54). Strabismus and abnormal eye movements were observed in 27.7% (15/54) and 33.3% (18/54) of eyes, respectively. Various systemic associations were periventricular leukomalacia (12/30), Down’s syndrome (6/30), seizure disorder (6/30), cardiac valvular anomalies (6/30), Marfan’s syndrome (4/30), hypothyroidism (4/30), rubella (3/20), cytomegalovirus (3/20), cerebral palsy (2/30), nephrotic syndrome (2/30), Type 1 diabetes mellitus (1/30), microcephaly (1/30), cryptogenic West syndrome (1/30), congenital rubella syndrome (1/30), and Tourette syndrome (1/30). The mean postoperative corrected distance visual acuity (CDVA) at 2?year follow?up improved to 1.0 logMAR (0 to 3 logMAR). No postoperative complications were reported at the final follow?up. Around 70% of the parents reported improvement in their child’s psychomotor skills. Conclusion: Intellectually impaired pediatric patients with cataract should be operated upon whenever there is a presence of infrastructure, and unnecessary delay in surgery should be avoided by referring the patient to higher centers. Even though objective improvement in visual acuity was suboptimal, there was definitely an improvement in the psychomotor skills of the patients.
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Purpose: Prolonged postoperative topical corticosteroids are commonly given after pediatric cataract surgery to control inflammation. This study was undertaken to compare the efficacy, safety, and compliance of postoperative topical steroids and adjunctive intracameral (I/C) triamcinolone acetonide (tricort) and posterior subtenon (PST) triamcinolone in modulating postoperative inflammation after surgery. Methods: Forty?eight eyes of children with pediatric cataract between the ages of 5 and 10 years were randomized into three equal groups (T, I, S) before surgery. Group T received postoperative topical 1% prednisolone tapered over 4 weeks; Group I received adjunctive intraoperative I/C 1.2 mg/0.03 ml tricort and topical 1% prednisolone for 2 weeks postoperatively, and Group S received a single 0.5 ml (40 mg/ ml) PST tricort without topical steroids. Signs of inflammation, intraocular pressure (IOP), and central corneal thickness were assessed at day 1, week 1, week 3, week 6, and week 12 postoperatively with optical coherence tomography (OCT) macula to rule out cystoid macular edema at the sixth and 12th weeks postoperatively. Results: Posterior synechiae were present in two eyes out of 16 in groups T and I, which resolved. Severe anterior chamber cells were present in four eyes out of 16 in group T, in two eyes in group I, and in one eye in group S, which resolved. All groups had comparable pre? and postoperative IOP. Conclusion: In pediatric cataracts, outcomes were better with PST tricort and the adjunctive I/C tricort compared to postoperative topical prednisolone, for modulating postoperative inflammation
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AIM: To observe the clinical outcomes of femtosecond laser-assisted cataract phacoemulsification combined with anterior vitrectomy in the treatment of pediatric cataracts.METHODS: Retrospective study. A total of 10 patients(17 eyes)diagnosed as pediatric cataract in Foshan Aier Eye Hospital from January 2021 to September 2022 were collected, including 5 males(9 eyes)and 5 females(8 eyes), with an age of 3～9(4.50±1.20)years old. All children underwent femtosecond laser assisted phacoemulsification combined with anterior vitrectomy. The visual acuity, intraocular pressure and pigment deposits of intraocular lens(IOL)surface, synechia and hyperplasia of posterior capsule lens at 1wk, 1 and 6mo postoperatively were observed during the 6mo follow-up.RESULTS: All surgical procedures were successful, and there was no serious complication intraoperatively or postoperatively. BCVA(LogMAR)was 0.63±0.18 preoperatively and 0.42±0.10, 0.32±0.09, and 0.22±0.08 at 1wk, 1 and 6mo postoperatively(all P<0.001). There was no difference in the comparison of intraocular pressure at different times of surgery(P=0.125). There was no statistically significant difference in the incidence of IOL surface pigment deposits, synechia, and posterior capsule lens hyperplasia at different times after surgery(P>0.05). The incidence of IOL surface pigment deposits at 1wk, 1 and 6mo after surgery was 3 eyes(18%), 1 eye(6%), and 1 eye(6%), respectively, the incidence of synechia was 0 eye, 1 eye(6%), 2 eyes(12%), and the incidence of posterior capsule lens hyperplasia was 0 eye, 0 eye, and 2 eyes(12%), respectively.CONCLUSION: Femtosecond laser-assisted cataract phacoemulsification combined with vitrectomy for the removal of the anterior vitreous can effectively prevent anterior capsular tear and the occurrence of posterior capsule opacification.
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Purpose: To evaluate the central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) changes on spectral domain optical coherence tomography (SD?OCT) after cataract surgery with intraocular lens (IOL) implantation in a pediatric population. Methods: This was a longitudinal, prospective, interventional study which included 90 pediatric patients who underwent cataract extraction with IOL implantation. Serial SD?OCT scans were done at postoperative day 1, 1?month, and 3?month follow?up. CMT and SFCT were measured at each visit. Results: A statistically significant increase in CMT was noted at 1 month (from 199.3 ?m to 210.04 ?m) post surgery, which declined over a 3?month period (202.70 ?m, P = 0.0001). In case of SFCT, a constant increase was observed for over 3 months of follow?up (baseline: 296.52 ?m; 1 month: 309.04 ?m; and 3 months: 319.03 ?m, P = 0.0001). The traumatic cataract group showed more pronounced changes in CMT and SFCT than the non?traumatic cataract group. No significant difference was observed regarding these parameters between those who underwent primary posterior capsulotomy (PPC) versus those who did not. None of the patients in the study group developed cystoid macular edema. These posterior segment–related anatomical changes did not affect the final visual outcomes. Conclusion: Cataract surgery induces potential inflammatory changes in the macula and choroid in pediatric patients. Such changes are more pronounced in trauma?related cases; however, they are not significant enough to affect the visual outcomes. Similarly, the additional surgical step of PPC does not induce significant anatomical or functional changes
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Purpose: To analyze intraoperative difficulties and visual and surgical outcomes following pediatric cataract surgery. Methods: This five?year retrospective study (2014�19) included 138 eyes (85 children) with cataract aged between 12 months and 18 years (either sex). All children had undergone best?corrected visual acuity (BCVA), anterior and posterior segment evaluation, intraocular lens (IOL) power calculation, superior manual?small?incision cataract surgery (MSICS) with or without posterior capsulotomy/anterior vitrectomy and IOL implantation under general or local anesthesia, visual rehabilitation, and had been followed up for a minimum period of 12 months. Results: The mean age was 111.27 � 4.84 months. Preoperative BCVA distance: 113 (81.88%)eyes had BCVA < 6/60; near BCVA: 114 (82.6%) eyes had ?N36. At last postoperative follow?up (mean: 20.98 � 13.08 months): distant BCVA? ?6/60 had been recorded in 120 (86.96%) eyes; near BCVA? >N36 in 123 (89.13%) eyes. Improvement in BCVA was statistically significant. Intraoperative scleral tunnel difficulties were seen in three eyes (thin flap in two, and buttonhole in one eye); in the majority of the eyes 113 (81.88%), IOL was placed in the bag. Twenty eyes had early postoperative inflammation. At last follow?up: posterior capsular opacity was recorded in six eyes, IOL decenteration in two eyes, secondary glaucoma in six eyes, and severe amblyopia in 36 (26.09%) eyes. The mean myopic shift was ? 1.11 � 0.89 D and was statistically significant. Conclusion: Superior MSICS as a treatment for pediatric cataract has minimal intraoperative complications and satisfactory visual and surgical outcomes.
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Purpose: The study sought to describe the clinical presentation pattern of pediatric cataracts and factors leading to delay in surgery at a tertiary care center in North India. Methods: A cross?sectional, interview?based study was conducted from January 2020 to October 2020, that included pediatric patients <12 years, with unilateral or bilateral congenital or developmental cataract. A pre?validated questionnaire was used to record data. The parameters recorded were age at first symptoms, age at diagnosis of cataract, age at surgery, laterality of cataract, first symptom, first family member noticing the abnormality, the morphology of cataract, association of perinatal complications, family history, systemic diseases, and cause (s) of delay in surgery. Results: A total of 89 patients were included. The mean age of subjects was 4.75(±3.51) years. A white pupil was the most common symptom (64.04%) and appeared in infancy in 30.3% of cases. Parents first detected the problem in 60.67%, and the pediatrician was the first medical contact in 11.23% of cases. The median (IQR) delay period between diagnosis of cataract and cataract surgery was 4 (3–6) months, the major causes were long GA waiting (30.33%), and delay due to systemic ill health (14.61%). Conclusion: Parental education on cataract detection is recommended to help in the timely detection and hence, improved outcomes of pediatric cataract surgery. Pediatricians, consulted for any systemic illness, have the role of the second most important contact in the detection of pediatric cataract.
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Purpose: To assess the cost of pediatric cataract surgery in a tertiary eye care hospital from a provider’s perspective. Methods: Retrospective review of direct costs incurred for pediatric cataract surgery for the financial year April 1, 2018, to March 31, 2019. The cost analysis was done by standard costing methods. The fixed cost included the cost of land, buildings, construction, maintenance, personnel, operation theater (OT), and Out patient department (OPD) equipment. The variable cost included the cost of consumables used during surgery. The indirect costs were not considered. Results: The per?patient fixed facility cost was INR 1.52 ($0.02), maintenance cost was INR 39.06 ($0.55), OPD equipment and consultation were INR 19.64 ($0.28), OT equipment was INR 467.95 ($6.61), the cost for personnel was INR 5,300.33 ($74.92), and the cost of consumables varied between INR 16,418 ($314.44) and INR 22,313 ($397.76), with the choice of intraocular lenses (IOL) being the main determining factor. The net average cost for a pediatric cataract surgery varied between INR 22,246.50 ($ 314.44) and INR 28,141.50 ($ 397.76). Conclusion: Pediatric cataract surgeries are cost?intensive. High?volume surgeries and an increase in the number of patients in OPD reduce the fixed facility cost. But there is an overall increase in human resource (HR) and consumable cost owing to economic and technological reforms. However, the impact of operating a child, thereby, increasing his/her blindness?free years probably outweighs the cost and justifies it. High patient inflow, increased number of surgeries, and bulk purchase of consumables help in decreasing the cost.
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We describe the technique of posterior optic capture without anterior vitrectomy in two difficult cases of pediatric cataract. We demonstrate how a three?piece foldable intraocular lens can be maneuvered behind the posterior capsule after an improvised posterior capsulotomy. This technique provided excellent intraocular lens (IOL) stability with the absence of lens epithelial cell proliferation in infants with altered posterior capsule morphology
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ABSTRACT Purpose: The purpose of this study was to analyze the safety of primary intraocular lens implantation in a large number of eyes in children aged <24 months. Methods: The medical records of patients aged 5-24 months, who underwent primary intraocular lens implantation in the capsular bag, were reviewed. A foldable three-piece acrylic intraocular lens was implanted by the same surgeon using a single surgical technique. Patients who had <1 year of follow-up after the surgery were excluded. The main outcome measurements included visual acuity, myopic shift, follow-up complications, and additional surgeries. Results: Sixty-eight patients (93 eyes) were analyzed. The mean age of the patients at the time of surgery was 15.06 ± 6.19 months (range: 5-24 months), and the spherical equivalent 1 month after surgery was 3.62 ± 2.32 D. After 5.67 ± 3.10 years, the spherical equivalent was -0.09 ± 3.22 D, and the corrected distance visual acuity was 0.33 ± 0.33 and 0.64 ± 0.43 logMAR in bilateral and unilateral cases, respectively (p=0.000). The highest myopic shift was observed in infants who underwent surgery at ages 5 and 6 months. The most frequent complications included visual axis opacification and corectopia. Glaucoma and retinal detachment were not reported. Conclusion: Primary in-the-bag intraocular lens implantation in children aged 5-24 months is safe, and is associated with low rates of adverse events and additional surgery.
RESUMO Objetivo: O objetivo deste estudo foi analisar a segurança do implante de lente intraocular primária em um grande número de olhos em crianças <24 meses. Métodos: Foram revisados os prontuários de pacientes com idade entre 5-24 meses, submetidos a implante primário de lente intraocular no saco capsular. Uma lente intraocular acrílica de três peças dobrável foi implantada pelo mesmo cirurgião usando uma única técnica cirúrgica. Pacientes que tiveram <1 ano de acompanhamento após a cirurgia foram excluídos. Os principais resultados incluíram medidas de acuidade visual, mudança miópica, complicações pós operatórias e cirurgias adicionais. Resultados: Foram analisados 68 pacientes (93 olhos). A média de idade dos pacientes no momento da cirurgia foi de 15,06 ± 6,19 (5 a 24) meses, e o equivalente esférico 1 mês após a cirurgia foi de 3,62 ± 2,32 D. Após 5,67 ± 3,10 anos, o equivalente esférico foi de -0,09 ± 3,22 D, e a acuidade visual corrigida à distância foi de 0,33 ± 0,33 e 0,64 ± 0,43 logMAR em casos bilaterais e casos unilaterais, respectivamente (p=0,000). A maior mudança míopica foi observado em bebês submetidos à cirurgia aos 5 e 6 meses de idade. As complicações mais frequentes incluíram opacificação do eixo visual e corectopia. Glaucoma e descolamento de retina não foram relatados. Conclusão: O implante primário de lente intraocular no saco capsular em crianças de 5-24 meses é seguro e está associado à baixas taxas de eventos adversos e cirurgias adicional.
Subject(s)
Child , Child, Preschool , Humans , Infant , Cataract Extraction , Lenses, Intraocular , Postoperative Complications , Retrospective Studies , Follow-Up Studies , Lens Implantation, Intraocular/adverse effectsABSTRACT
@#AIM:To systematically compare and evaluate the clinical efficacy of intraocular lens(IOL)incarceration and non-incarceration in pediatric cataract.<p>METHODS: Literatures were searched from domestic and foreign databases such as PubMed, Embase, Cochrane Library, Wanfang, and CNKI, and the paper editions of relevant journals were consulted as well. The retrieval period of literature was from January 2000 to January 2021. The screened literatures were evaluated and extracted by two experienced researchers. After performing the evaluation guidelines of Cochrane collaboration and the Newcastle-Ottawa Scale(NOS), the Rev Man 5.4 software was applicated to complete the Meta-analysis.<p>RESULTS:Seven references(328 eyes)were involved in this analysis. The results of the Meta-analysis showed that the two groups had statistically significant differences in best corrected visual acuity(BCVA)>0.5 eyes(<i>RR</i>=2.00, 95%<i>CI</i>: 1.18-3.37, <i>P</i>=0.01), IOL shift(<i>RR</i>=0.28, 95%<i>CI</i>: 0.17-0.46, <i>P</i><0.00001)and mild or above opacification of the visual axis(<i>RR</i>=0.35, 95%<i>CI</i>: 0.19-0.65, <i>P</i>=0.0007)after surgery. However, there was no significant difference in the occurrence of posterior synechia(<i>RR</i>=0.67, 95%<i>CI</i>: 0.10-4.33, <i>P</i>=0.67)and very mild opacification of the visual axis(<i>RR</i>=1.05, 95%<i>CI</i>: 0.64-1.73, <i>P</i>=0.84).<p>CONCLUSION:IOL incarceration in the treatment of pediatric cataract can significantly improve postoperative BCVA, reduce occurrence of IOL shift and prevent mild or above opacification of the visual axis, which has more advantages in overall clinical efficacy. But more high quality prospective studies should be still required for further analysis.
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Purpose: To find out the sociodemographic, sociocultural, and socioeconomic factors leading to delay in pediatric cataract surgery and its impact on final visual outcome. Methods: A prospective interview-based analytical cohort study was conducted on 156 children aged 0� years with either unilateral or bilateral congenital/developmental cataracts. Caregivers were interviewed using a pretested validated questionnaire. Time intervals between recognition by a caregiver to consultation were denoted as Delay-1 and between consultations to surgical intervention as Delay-2. Spearman's rank correlation was used to determine the presence of correlation between causes of delay and visual outcome. Results: The mean age of presentation was 7.78 � 4.34 years. Mothers were the first informant of the problem (n = 110, 70.5%). Out of 156 children, only 8 (5.1%) children presented to the hospital within 1 month by caregivers and 26 (16.7%) children underwent surgery within 2 months of advice. About 22 (14.1%) children had total cumulative delay of 1�months, 11 (7%) had delay of 6� months, and 115 (73.71%) had delay of >12 months. The most common cause identified for Delay-1 was unawareness in 41 cases (26.28%), however, for Delay-2 major factor responsible was cost (n = 38, 24.35%). The median preoperative visual acuity was 1.31 logMAR and median postoperative visual acuity at 4 weeks was 0.61 logMAR. (P < 0.001) Less age at surgery, upper socioeconomic status, less time delay, and better preoperative vision were positively correlated to better visual outcomes. Conclusion: Delay in presentation for childhood cataract surgery remains a significant problem in central rural India. Delay in surgery is multifactorial which includes unawareness, cost, misdiagnosis, self-treatment, distance from the hospital, lack of family support, and poor socioeconomic status.
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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.
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Purpose: To compare surgical outcome of two procedures in pediatric cataract surgery. Methods: Prospective randomised interventional study. Consecutive patients with bilateral congenital cataract who were operated during January 2016 to October 2016 at a tertiary care referral institute were included. One eye of all patients underwent Intraocular lens (IOL) implantation with optic capture through a primary posterior continuous curvilinear capsulorhexis (PPC) without vitrectomy while in the other eye endocapsular IOL implantation was performed along with PPC and anterior vitrectomy. Intraoperative challenges and postoperative complications were noted. Results: 15/18 children who fulfilled the inclusion criteria were included for follow up analysis. Mean age at the time of surgery was 21 � 14.7 months. At a mean follow up of 25.69 � 1.06 months; all eyes in both groups maintained a clinically centred IOL with clear visual axis. One patient with endocapsular IOL implantation developed anterior capsular phimosis. The rate of fibrinous complications (IOL deposits and synechiae) were more in the eyes with IOL in the bag (6 eyes) vs eyes where posterior optic capture was done (1 eye); P = 0.039. Conclusion: Posterior optic capture is a safer alternative to conventional pediatric cataract surgery in terms of inflammatory sequelae and lens epithelial cell proliferation. However the two methods work equally well in preventing visual axis obscuration over a long follow-up.
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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.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Cataract , Capsule Opacification , Lenses, Intraocular , Postoperative Complications , Prosthesis Design , Acrylic Resins , Prospective Studies , Phacoemulsification , Lens Implantation, IntraocularABSTRACT
Purpose: To prospectively evaluate the biometric changes in Indian pediatric cataract and postoperative refractive status. Methods: A total of 147 patients were recruited into three groups: age <6 months, age between 7 months and 18 months, and age between 19 and 60 months and prospectively observed for 6 months. Exclusion criteria were preterm birth, microphthalmia, microcornea, megalocornea, uveitis, glaucoma, and traumatic or complicated cataract. Axial length and keratometry, the primary outcome measures, were taken preoperatively under general anesthesia before surgery. These children were followed up for 6 months to look for refractive and biometric changes. T-test and linear regression with the logarithm of independent variables were done. Results: All unilateral cataractous eyes (n = 25) and randomly selected bilateral cases (n = 122) were included in the analysis, for a total of 147 eyes. Mean age was 17.163 ± 13.024 months; axial length growth was 0.21, 0.18, 0.06 mm/month, and keratometry decline was 0.083, 0.035, 0.001 D/month in age groups 0–6, 7–18, and 19–60 months, respectively. The visual acuity improved in log MAR from 1.020 to 0.745 at 6 months postoperatively. There was statistically significant (Spearman's correlation coefficient = –0.575, P < 0.001) between age and postoperative refraction. There were no intraocular lens (IOL)-related complications seen in the immediate postoperative period. Peripheral opacification was seen in 102 eyes and central opacification in 1 eye at a 6-month follow-up. Conclusion: Indian eyes have a lower rate of axial length growth and keratometry change in comparison with western eyes implying smaller undercorrection in emmetropic IOL power for Indian pediatric eyes to achieve a moderate amount of hyperopia.