Lens Aspiration Research Articles

Wavefront analysis and ultrastructural findings in an eye with posterior lentiglobus

An 8-year-old girl with unilateral posterior lenticoglobus underwent lens aspiration and intraocular lens implantation. Wavefront analysis performed before surgery to assess the surgical indication showed a higher-order aberration of 0.502 μm root mean square. After surgery, the value decreased to 0.132 μm root mean square. Preoperative best-corrected visual acuity of 0.1 improved to 0.3 postoperatively. Electron-microscopic examinations of the posterior capsule revealed unusual nodular structures and variations in capsular density.

Conjunctival Necrosis Due to Subconjunctival Depot Corticosteroid Injection

This report describes an uncommon complication of subconjunctival corticosteroid injection. A 34-year-old male had undergone primary corneal suturing and crystalline lens aspiration due to trauma in his right eye. At the end of the surgery, subconjunctival methylprednisolone acetate was injected. At a follow-up visit five days later, biomicroscopic examination revealed conjunctival necrosis at the site of corticosteroid injection. Topical antibiotherapy resulted in complete healing. Ophthalmologists should always keep in mind that subconjunctival corticosteroid injection may lead to conjunctival necrosis. (TOD Journal 2010; 40: 248-9)

Modern cataract surgery for radiation-induced cataracts in retinoblastoma

BackgroundSurgery of radiation-induced cataracts in children with retinoblastoma (RB) is a challenge as early intervention is weighted against the need to delay surgery until complete tumour control is obtained. This...

A necrotic ciliochoroidal malignant melanoma in a young Thai female

Background: Uveal malignant melanoma is not common among Asians and is rare in young people. Extensive necrosis of a tumor without prior treatment has scarcely been reported. Objective: To study the histopathology findings of a large uveal mass in a young female. Method: Review of clinical history, physical examination, ultrasonography, radiography, and histopathology were performed. Results: A 14-year-old Thai female with a past history of trauma presented with visual loss in her left eye. Total lens opacity was found. During the lens aspiration procedure, a dark ciliochoroidal mass was detected. A large uveal melanoma was suspected. The enucleated eye consisted of an extensively necrotic ciliochoroidal malignant melanoma with only tiny foci of the epithelioid cells at the tumor base. There was no extrascleral extension. A systemic work-up did not show extraocular involvement. Conclusion: We report a rare case of a large, necrotic type, uveal melanoma in a teenage Thai female.

23-Gauge-Lentektomie zur operativen Behandlung einer angeborenen Katarakt

Congenital cataract surgery can be performed using a pars plana/plicata approach if placement of an intraocular lens at the time of cataract removal is not a consideration. To prevent development of secondary cataract, we performed lens aspiration, anterior and posterior capsulotomy, and anterior vitrectomy via pars plana or pars plicata approach. Lentectomy in babies should be performed using a minimally invasive technique to prevent complications. Immediately after surgery, insertion of a contact lens should be possible. The series consisted of 11 eyes of 8 consecutive children who suffered from congenital cataract and underwent pars plana/plicata lentectomy between April 2007 and September 2008. Age at operation ranged from 6 weeks to 13 months (median age 4 months). The inclusion criterion was congenital cataract affecting the visual axis. Lentectomy was performed via a pars plana or pars plicata approach using a special 23-gauge aspiration and irrigation system and a 23-gauge cutter. We performed lens aspiration, anterior and posterior capsulotomy, and anterior vitrectomy. Postoperatively the eyes showed only mild signs of inflammatory reaction. At the end of the operation, all eyes were provided with contact lenses. For all eyes, the surgical technique provided a clear visual axis during the follow-up period of 2-18 months. One eye developed secondary cataract. The use of 23-gauge instruments has advantages over standard 20-gauge equipment. Pars plana/plicata lentectomy using 23-gauge instruments is a safe, effective, and minimally invasive method for treating cataract in babies.

Comparison of 2 techniques of intraocular lens implantation in pediatric cataract surgery

To compare the results of 2 intraocular lens (IOL) implantation techniques in pediatric cataract surgery. Labbafinejad Medical Center, Tehran, Iran. This contralateral prospective randomized study comprised children with bilateral congenital or developmental cataract. In all cases, anterior capsulorhexis, lens aspiration, posterior continuous curvilinear capsulorhexis (PCCC), and anterior vitrectomy were performed. In 1 eye of each patient, a 3-piece AcrySof MA60BM IOL was implanted in the capsular bag. In the other eye, the same type of IOL was implanted in the ciliary sulcus and the optic was captured through the PCCC. Visual acuity, visual axis opacification, and complications were assessed. Twenty-eight eyes of 14 children were included in the study. The mean patient age at surgery was 5.1 years +/- 1.5 (SD) (range 2.5 to 8.0 years). The mean follow-up was 22.2 +/- 6.3 months (range 13 to 35 months). The visual axis remained clear in all eyes in both groups. There was no statistically significant difference between the 2 groups in best corrected visual acuity or complications (eg, postoperative uveitis, posterior synechia, significant IOL decentration). In pediatric cataract surgery, placement of haptics in the ciliary sulcus and IOL optic capture through the PCCC was a safe alternative to IOL implantation in the capsular bag.

Age at the time of cataract surgery and relative risk for aphakic glaucoma in nontraumatic infantile cataract

To report the relative risk for aphakic glaucoma as a function of age at surgery in infants who underwent cataract surgery before 10 months of age for nontraumatic infantile cataract without microcornea. This was an institutional retrospective case series (January 1985 to February 2003) of children who underwent cataract surgery without intraocular lens implantation for nontraumatic infantile cataract before 10 months of age. Patients with less than 5 years' postsurgical follow-up, microcornea, persistent fetal vasculature, and/or other significant anterior segment abnormality were excluded. The surgical procedure in all cases was lens aspiration, posterior capsulotomy, and anterior vitrectomy with anterior small-incision techniques. Of 210 eyes (121 patients), 55 eyes (26.2%; 31 patients [25.6%]) developed aphakic glaucoma. Relative risk for later aphakic glaucoma as a function of age at the time of surgery decreased from 1.85 (95% CI, 0.88-3.86) at 0-1 months of age to a nadir at 3-4 months of age (0.22 [95% CI, 0.05-0.96]) and then increased again to peak at 3.17 (95% CI, 1.1-9.11) at 5-6 months of age. The lowest relative risk for later aphakic glaucoma in our cohort was for surgery performed at 3-4 months of age, for which the 95% CI remained less than 1.0. Further conclusions are limited by overlapping confidence intervals. However, because of amblyopia issues, we do not recommend delaying congenital cataract surgery beyond 4 weeks of life.

Management of congenital cataract in children younger than 1 year using a 25-gauge vitrectomy system

To evaluate the safety and efficacy of a 25-gauge vitrectomy system for the management of congenital cataract in children younger than 1 year. Princess Margaret Hospital for Children, Western Australia, Australia. Children in a tertiary pediatric hospital and private practice had cataract extraction using a 25-gauge vitrectomy system between January 2005 and June 2008. Each eye had anterior vitrectorhexis, lens aspiration, posterior vitrectorhexis, and anterior vitrectomy through two 25-gauge limbal side ports. The ports were created with a 25-gauge trocar or a 0.6 mm paracentesis knife. The eyes were left aphakic. Nineteen (95%) of the 20 eyes (14 children) had a successful surgical outcome with the 25-gauge vitrectomy system. One eye was converted to the 20-gauge system because of an unusually tough and fibrous lens capsule. The limbal side ports in 16 of 17 eyes created with the 25-gauge trocar required suturing to seal the ports; none of the 3 eyes with side ports created with the paracentesis knife required suturing. There were no significant intraoperative or postoperative complications other than ocular hypertension in 1 eye. The 25-gauge vitrectomy system appears safe and effective for the management of infantile cataract. Advantages include more precise manipulations with smaller instruments in infant eyes, a more stable anterior chamber, and less postoperative astigmatism.

Safety of Primary Intraocular Lens Insertion in Unilateral Childhood Traumatic Cataract

This study analyzes the results of cataract surgery with primary intraocular lens implantation in unilateral childhood traumatic cataract following penetrating trauma and its long term follow up. It is a hospital based study of 114 children (age 3-10 years) with unilateral traumatic cataract who underwent extracapsular cataract extraction/ lens aspiration with implantation of posterior chamber intraocular lens (IOL). Primary posterior capsulotomy (PPC) was performed in 57 eyes and the rest 57 were without PPC (NPPC). The patients were followed up at regular intervals for a period of 3 years. Postoperative inflammation and pupillary capture were two frequent complications seen during postoperative period. Development of posterior capsular opacification (PCO) was 1/57, 4/57 at 8th week and 7/30 and 14/39 at 6 months, in PPC and NPPC group, respectively. Best corrected visual acuity (BCVA)>or=6/18 was achieved in 50% of eyes at 8th week post operatively and the same at 3 years with/without membranectomy/capsulotomy was evident in 73.3% of eyes. Meticulous case selection with insertion of "in the bag IOL" and subjecting the traumatized cataractous eyes to primary posterior capsulotomy are factors responsible for optimal outcome in unilateral traumatic cataract in children.

301: Comparison of Topical Lignocaine Gel and Fentanyl for Perioperative Analgesia in Children Undergoing Lens Aspiration

301: Comparison of Topical Lignocaine Gel and Fentanyl for Perioperative Analgesia in Children Undergoing Lens Aspiration

Comparison of Topical Lignocaine Gel and Fentanyl for Perioperative Analgesia in Children Undergoing Lens Aspiration

Comparison of Topical Lignocaine Gel and Fentanyl for Perioperative Analgesia in Children Undergoing Lens Aspiration

301. Comparison of Topical Lignocaine Gel and Fentanyl for Perioperative Analgesia in Children Undergoing Lens Aspiration

301. Comparison of Topical Lignocaine Gel and Fentanyl for Perioperative Analgesia in Children Undergoing Lens Aspiration

Intraoperative performance and postoperative outcomes of endocapsular ring implantation in pediatric eyes

To study the intraoperative performance and postoperative outcomes of Cionni modified capsule tension ring (CTR) and intraocular lens (IOL) implantation in the capsular bag in pediatric eyes with ectopia lentis. John A. Moran Eye Center, Salt Lake City, Utah, USA. Thirty-five eyes (22 children) with ectopia lentis and visually significant cataract that had lens aspiration and in-the-bag implantation of single-piece AcrySof IOL and Cionni CTR were included. Single- and double-eyelet CTRs were used. The rings were sutured to the sclera using 9-0 or 10-0 polypropylene (Prolene) sutures. Preoperative and postoperative best corrected visual acuity (BCVA), intraoperative performance, IOL centration, and complications were studied. The mean patient age was 8.2 years +/- 5.1 (SD) and the median follow-up, 28 months. A double-eyelet CTR was implanted in 12 eyes and a single-eyelet CTR, in 23 eyes. The mean BCVA at the final follow-up (0.37 +/- 0.25 logMAR, 33 eyes) was significantly better than preoperatively (0.78 +/- 0.42 logMAR, 28 eyes) (P = .003). At the last examination, the BCVA was 20/40 or better in 16 eyes (45.7%). Three eyes (8.5%) required resuturing for IOL decentration. Nineteen eyes (54.3%) had a secondary procedure for posterior capsule opacification. Other complications included anterior capsule opacification (2.85%), cystoid macular edema (5.71%), chronic uveitis (5.71%), and vitreous prolapse (2.85%). Implantation of the Cionni CTR and single-piece AcrySof IOL in the capsular bag in pediatric eyes with subluxated lenses was safe and effective and led to a stable IOL with few significant complications.

Risk Factors for Complications After Congenital Cataract Surgery without Intraocular Lens Implantation in the First 18 Months of Life

To determine individual risk factors for the development of postoperative complications after pediatric cataract surgery in the first 18 months of life. Interventional, consecutive case series. We retrospectively reviewed the records of 71 eyes of 46 children who underwent surgery for congenital cataract within the first 18 months of life. A limbal approach bimanual lens aspiration, posterior capsulorrhexis, and anterior vitrectomy without intraocular lens implantation was performed in all children. We examined the interrelationships of operative and postoperative complications with other variables such as patient age, family history, or ocular abnormalities. The mean follow-up period was 39 months. The most frequent postoperative complications were late-onset open-angle glaucoma (10.8%) and vitreous hemorrhage (10.8%), whereas early-onset glaucoma (4.6%) was less common. Secondary cataract was observed in seven eyes (9.2%). We determined a family history of aphakic glaucoma in first-degree relatives (P = .007) as well as cataract surgery in the first three months of life (P = .039) and nuclear cataracts (P = .0009) to be strong predictors of late-onset glaucoma. Secondary cataract formation was associated strongly with lensectomy in the first five months of life. The diagnosis of postoperative hemorrhages was associated significantly with the presence of persistent fetal vasculature (P < .0001). Patients with preoperative predictors at presentation such as young age at the time of surgery, a family history of aphakic glaucoma, nuclear cataract, or persistent fetal vasculature syndrome offer a clear target for extensive postoperative care after congenital cataract surgery.

Performance of the Acri.Smart 46S intraocular lens in pediatric microincision cataract surgery

To evaluate the performance of the microincision Acri. Smart 46S intraocular lens (IOL) (Acri.Tec) in pediatric cataract surgery. Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany. Thirty-two consecutive eyes of 22 children who had cataract surgery with planned IOL implantation were retrospectively analyzed. Intraoperative and postoperative IOL performance, posterior capsule opacification (PCO) formation, best corrected far and near visual acuities, and astigmatism were analyzed. The minimum follow-up was 12 months. The median patient age was 4.5 years (range 2 to 13 years) and the median follow-up, 21 months (range 12 to 29 months). In 94% of eyes, the IOL was implanted in the capsular bag; in 6%, it was placed in the ciliary sulcus. A primary posterior capsule opening was created in 12.5% of eyes. The posterior capsule was intact at the end of surgery in 81% of eyes. Capsule rupture occurred during lens aspiration in 3% of eyes, and a primary capsular defect was present in a patient with traumatic cataract. Posterior capsule opacification that required a second intervention during the follow-up period developed in 35% of eyes. All IOLs were well centered and had a clear optical axis at the end of follow-up. The Acri. Smart (46S) IOL was found to be suitable for pediatric bimanual microincision cataract surgery. The feasibility of inserting the IOL through of the sub-2.0 mm paracentesis minimizes manipulation of the juvenile eye.

Megalocornea and bilateral developmental cataracts

We present the case of a 9-year-old boy with megalocornea and juvenile cataracts. Bilateral lens aspiration and acrylic intraocular lens (IOL) implantation were performed under general anesthesia. After the surgery, both IOLs gradually decentered. Posterior capsule opacification was a further complication, necessitating bilateral neodymium:YAG (Nd:YAG) capsulotomy under local anesthesia. Five years after the Nd:YAG capsulotomy, the decentered IOLs remained in the same position and the vision remained stable with glasses. Cataract extraction in megalocornea is difficult, and complications are frequent. The type of IOL, IOL size, and need for surgery should be carefully considered.

Diagnosis and management of corneal keloid

A 29-year-old man presented with a slowly growing mass in his left eye for the past 6 months. He had undergone a lens aspiration for traumatic cataract with an anterior chamber intraocular lens implantation several years ago. On examination, a pearly white mass was seen on the cornea. Ultrasound biomicroscopy revealed a hyperdense mass well demarcated from the underlying corneal tissue. The mass was excised by superficial keratectomy and the bare stroma covered with amniotic membrane. Histopathological examination of the excised mass revealed findings consistent with the diagnosis of a corneal keloid. At follow up after 6 months, no recurrence was observed.

Intralenticular metal foreign body: case report

Intralenticular foreign bodies comprise about 5% to 10% of all intraocular foreign bodies and can result in serious complications. The management depends on some factors like size, location, material type and the risk of infection. We present a patient with an intralenticular metal foreign body in the left eye that, following initial treatment with topical steroid and antibiotic, underwent lens aspiration with removal of the intralenticular foreign body and insertion of a posterior chamber intraocular lens with good visual outcome.

The use of peribulbar anaesthesia in paediatric cataract surgery (age 7–15 years) in a mobile eye camp in China

To evaluate the feasibility and acceptability of the use of peribulbar anaesthesia (PA) in paediatric cataract surgery in rural areas in China, where there are limitations in expertise and equipment for general anaesthesia (GA). We prospectively evaluated the feasibility and acceptability of carrying out paediatric cataract surgery under PA in children aged 7-15 years. Informed consent was obtained from the subjects and their parents. Children were assessed for their suitability for PA. Peribulbar anaesthesia was given as a peribulbar block using a 2% lidocaine, 0.5% bupivacaine-hyaluronidase mixture administered before lens aspiration with intraocular lens implantation. The acceptability of the PA was evaluated by questionnaire. A total of 19 patients were recruited. Their mean age was 12 +/- 2 years (range 7-15 years). None required conversion to GA. All subjects regarded PA as either totally acceptable (63.2%) or acceptable (36.8%). The mean pain scores (from 0 to 100) during the injection and surgery were 28 +/- 26 and 6 +/- 8, respectively. Seventeen patients (89.5%) said they would prefer PA if choices in anaesthesia were offered again. Peribulbar anaesthesia can be considered as a viable option in selected children undergoing cataract surgery when facilities for safe and optimal general anaesthesia are unavailable.

Implantation of foldable intraocular lens with anterior optic capture in isolated posterior capsule rupture

We would like to raise several pertinent points regarding isolated posterior capsule rupture occurrence and its management described in the article by Pushker et al.1 Isolated posterior capsule rupture is a well-recognized clinical entity. In our literature review, we came across 22 cases reported prior to the authors' case.2–9 Previous authors suggest that the absence of a formed nucleus in young patients allows contrecoup forces to be transmitted through the lens substance.3 We theorize that its occurrence in young patients following blunt trauma is due to localized pressure buckling the cornea and deforming the soft nucleus (with posterior bulging against the posterior capsule). In addition, zonular tension pulls the posterior capsule centrifugally. This combination results in a blow-out rupture of the posterior capsule. We recently managed a similar case. Two months following blunt ocular trauma, a 19-year-old man had lens aspiration with implantation of an Alcon MA60BM intraocular lens (IOL) in the capsular bag. We aspirated the lens through a superior 2.75 mm clear corneal incision using automated irrigation/aspiration with an anterior chamber maintainer (ACM). With low-flow settings and the ACM, no vitreous prolapsed and anterior vitrectomy was not required. The posterior chamber IOL was placed in the capsular bag, with no optic capture, and has remained stable with over 1 year of follow-up. Even without grossly fibrotic edges, these posterior capsular defects are relatively stable and resistant to enlargement like posterior capsulorhexis. In essence, we feel that vitreous loss should be avoided with the attendant reduction in the risk for retinal detachments and cystoid macular edema. Plain capsular bag fixation is also possible in most cases and is ideal because prolapsing the optic anteriorly brings it closer to the iris and increases the risk for iris chafing and pigment dispersion. If the defect is extremely large or the edges of the posterior capsule defect are not visualized, the posterior chamber IOL haptics should be placed in the ciliary sulcus (with posterior optic capture through an intact anterior capsulorhexis). In fact, anterior optic capture was recommended by Gimbel and DeBroff10 in cases in which the posterior capsule tear occurred during or after posterior chamber IOL insertion rather than in cases with preexisting breaks. In cases of posterior capsule tear during or after posterior chamber IOL insertion, leaving the haptics in the capsular bag, rather than trying to dial them out into the sulcus, minimizes vitreous disturbance. Finally, we would like to point out that the Alcon MA30BA has polymethyl(methacrylate) haptics not polypropylene haptics as mentioned by the authors.