Piggyback intraocular lens implantation for management of congenital cataract in infants

Managing cataract in children remains a challenge, infants need intraocular lenses [IOLs] that are very powerful and usually not commercially available and myopic shift will occur when the eyes grow in size, to reduce this problem two IOLs may be placed in the baby's eye at the same time [Piggyback]. This work is done to evaluate the efficacy and safety of this procedure. This study included 13 eyes of 11 infants [7 males and 4 females] ranging in age from 7 to 18 months, cataract extraction was done through a limbal incision, anterior capsulorhexis with or without trypan blue staining, irrigation and aspiration of lens matter, a primary posterior capsulorhexis using trypan blue dye and anterior vitrectomy. Two polymethy lmethacrylate [PMMA] IOLs were implanted one posterior inside the capsular bag of a higher power and the second anterior in the sulcus of a lower power to be removed in the future. SRK - T formula was used to calculate the IOL power the patients were followed up postoperatively for 12 months. The mean axial length at the time of surgery was 19.97mm. The mean total IOL power was 32.96 D, the mean implanted posterior IOL power was 21.84D, the mean implanted anterior IOL power was 10.61D. The mean first postoperative spherical equivalent [SE] of the refraction was + 0.73D, the mean last postoperative SE of the refraction after 12 months was - 2.53D. The mean last postoperative axial length after 12 months was 22.05mm. Postoperative mild to moderate iridocyclitis occurred in 6 eyes [46.15%]. Mild decentration happened in 2 eyes [15.38%] of both the anterior and posterior lenses. Moderate peripheral posterior capsule opacification [PCO] developed in 3 eyes [23.07%]. Mild anterior and posterior IOL deposits occurred in 4 eyes [30.76%] and mild posterior synechia occurred in 2 eyes [13.38%]. In conclusion, Piggyback IOL implantation in infancy is feasible, good results obtained, complications can be reduced by implanting the anterior lens in the sulcus, intracameral injection of a miotic and good suturing of the incision and the side ports. Further follow up and more evaluation are required

Modified parameters of phacoemulsification in high myopia

Phacoemulsification is more challenging in high myopia than in other eyes because the globe is superelongated and the sclera is thinned out. This study aimed at overcoming the technical difficulties encountered in high myopic eyes by modifying the parameters of phacoemulsification. This study included 30 eyes of 20 patients, 13 males and 7 females [ranging in age from 44 to 62 years]. Their axial lengths ranged from 28 to 32 mm., they had posterior cortical and nuclear cataract [nuclear hardening were grade II and grade III]. The incision was clear corneal tunnel starting posteriorly limbal, the technique of choice was divide and conquer phacoemulsification keeping the bottle height constant at 70cm. in all phacoemulsification steps phaco I, phaco II and irrigation- aspiration [I / A]. Phacoemulsification of high myopic eyes with standard phaco parameters is associated with many difficulties, like fluctuation of anterior and posterior chambers and impairement of good visualization, also there is increased risk of posterior capsule rupture and zonular dialysis. Our results on using the new phaco parameters were very promising, there was no fluctuation of anterior and posterior chambers encountered, the visualization of the nucleus during emulsification and the posterior capsule during I / A was very good in all cases and no cases of posterior capsule rupture or zonular dialysis were recorded. In conclusion phacoemulsification of high myopic eyes with modified parameters offered us better visualization, reduction of the load on the lens ligaments apparatus and facilitated the manipulations made oh the lens nucleus and cortical matter cleaning out