Biometric changes in Indian pediatric cataract and postoperative refractive status.

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.

Pediatric cataract.

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.

Innovations in pediatric cataract surgery.

Advances in technology have made surgery in children safer and faster. The management of pediatric cataract has made rapid progress in the past decade with the availability of safer anesthesia, newer technique's, more predictable intraocular lens (IOL) power calculation, a better understanding of neurobiology, genetics, amblyopia management, improved IOL designs for preventing visual axis opacification, and adjuvant postoperative care. Modern vitrectomy machines with minimally invasive instruments, radiofrequency, diathermy, and plasma blades help immensely in complicated cases. Preoperative evaluation with ultrasound biomicroscopy and optical coherence tomography (OCT) allows better planning of surgical procedure. The future holds good for stem cell research, customized OCT, and Zepto (precision pulse capsulotomy).

A novel technique to release sticking haptic of a single-piece hydrophobic acrylic IOL using irrigation-aspiration probe.

PURPOSE: To describe a novel technique to release sticking haptic of a single-piece hydrophobic acrylic intraocular lens (IOL) using irrigation-aspiration (I/A) probe. METHODS: In our technique, the I/A probe is introduced into the anterior chamber on Visco mode. Using the aspiration port of the I/A probe, the sticking haptic is held at its tip and suction force is built up until occlusion is noted. Then the haptic is nudged towards the center of the IOL along its curve. After the haptic is free from optic, the suction is released. RESULTS: Several techniques have been described to release the sticking haptic such as squeezing the haptic at the site where it sticks to the IOL or using Sinskey hook for releasing the adhesion. These techniques require extra manipulation of the IOL by introduction of surgical instruments. In our technique, we used the I/A probe itself for separating the sticky haptic successfully. CONCLUSIONS: This technique allows separation of sticking haptic without any extra instrumentation, thus reducing intraocular maneuvering and total surgery time.

Comparison of color perception after tinted blue light-filtering and clear ultraviolet-filtering intraocular lens implantation.

PURPOSE: To compare color perception after implantation of clear and yellow-tinted intraocular lenses (IOLs). SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. DESIGN: Comparative case series. METHODS: This study evaluated eyes that had implantation of an Acrysof IQ SN60WF yellow-tinted IOL or an Acrysof SA60AT clear IOL. All eyes were evaluated postoperatively at 1 month and 3 months. The uncorrected distance visual acuity, intraocular pressure, and color vision (Ishihara pseudoisochromatic test, Edridge-Green lantern test, Heidelberg anomaloscope, and Farnsworth-Munsell (FM) 100-hue test) were evaluated. RESULTS: Both IOL groups comprised 50 eyes. There were no significant differences between the 2 groups in color vision on any of the 4 tests (P≥.05). Plotting the error scores on the polarity graph of the FM 100-hue test showed that eyes with a yellow-tinted IOL did not have a specific axis of confusion. CONCLUSION: There was no difference in color perception between the 2 IOLs irrespective of the color vision test used.