Limbal Approach Research Articles

Simplified ab externo fixation technique to treat late dislocation of scleral-sutured polymethyl methacrylate intraocular lenses.

PurposeWe report a simplified ab externo scleral fixation technique to manage the late dislocation of scleral-sutured polymethyl methacrylate (PMMA) intraocular lenses (IOLs) in the absence of capsule support.Materials and methodsThe technique was performed on five eyes of five patients. Symmetrical scleral pocket tunnels without conjunctival peritomy were created. An anterior vitrectomy via a limbal approach with an anterior chamber infusion or a 3-port pars plana vitrectomy was performed to rescue the dislocated IOL. A long straight suture needle and 23-gauge vitreoretinal forceps were used to conveniently reposition the IOL and loop sutures through the IOL positioning eyelets without externalizing IOL haptics. The outside suture knots were buried under the roof of the scleral tunnels.ResultsThe patients were followed for 5-14 months after surgery. All the operated eyes quickly recovered with negligible corneal endothelial cell loss and mild inflammation. Visual acuity improvement and IOL centration were achieved in all eyes with no major complications.ConclusionThe simplified ab externo scleral fixation technique offers an effective and minimally invasive surgical alternative to salvage dislocated previously scleral-sutured PMMA IOLs.

Comparison between Limbal and Pars Plana Approaches Using Microincision Vitrectomy for Removal of Congenital Cataracts with Primary Intraocular Lens Implantation

Purpose. To compare the surgical outcomes of limbal versus pars plana vitrectomy using the 23-gauge microincision system for removal of congenital cataracts with primary intraocular lens implantation. Methods. We retrospectively reviewed all eyes that underwent cataract removal through limbal or pars plana incision. Main outcome measures included visual outcomes and complications. Results. We included 40 eyes (26 patients) in the limbal group and 41 eyes (30 patients) in the pars plana group. The mean age was 46 months. There was no significant difference in best-corrected visual acuity between the two groups (P = 0.64). Significantly, more eyes had at least one intraoperative complication in the limbal group than in the pars plana group (P = 0.03) that were mainly distributed at 1.5–3 years of age (P = 0.01). The most common intraoperative complications were iris aspiration, iris prolapse, and iris injury. More eyes in the limbal group had postoperative complications and required additional intraocular surgery, but the difference was not significant (P = 0.19). Conclusions. The visual results were encouraging in both approaches. We recommend the pars plana approach for lower incidence of complications. The limbal approach should be reserved for children older than 3 years of age and caution should be exercised to minimize iris disturbance.

A survey of the surgical treatment of congenital and developmental cataracts in Japan.

To understand the current practice pattern for the surgical treatment of congenital/developmental cataracts in Japan. A mail questionnaire was sent to facilities engaged in the surgical treatment of congenital cataracts in Japan. Thirty-four facilities reported their preferred methods for the surgical treatment of congenital cataracts, including data from 809 eyes of 508 patients who had undergone surgery. More than 85% of the respondents answered that they would consider surgery even if the visual prognosis was not promising because of possible form-deprivation amblyopia. The most commonly performed surgical maneuvers were scleral tunnel incision (88.4%), 3.0-mm or smaller incision (78.8%), manual anterior continuous curvilinear capsulorhexis (90.2% success rate), posterior capsulotomy (92.5% for patients aged ≤6 years), anterior vitrectomy by the limbal approach (85.9% for patients aged ≤6 years), and wound closure with sutures (93.2%). Posterior capsulotomy and vitrectomy were not usually performed in patients aged >6 years. Implantation of an intraocular lens (IOL) was mostly indicated in patients aged 2 years or older. Implantation of an acrylic foldable IOL (76.6%) into the capsular bag (89.7%) was the most common practice among the surgeons. Small incision surgery with implantation of an acrylic foldable IOL into the capsular bag combined with posterior capsulotomy was the preferred surgical treatment of choice for congenital/developmental cataracts.

Relationship between raised intraocular pressure and ischemia-modified albumin in serum and humor aqueous: a pilot study in rabbits.

We evaluated the relationship between increased intraocular pressure (IOP), ischemia-modified albumin levels in serum (IMA-s) and in humor aqueous (IMA-HA) in rabbits. Twenty-five albino New Zealand rabbits weighing between 2.0 and 2.8 kg were used in this pilot study. With permission from Canakkale Onsekiz Mart University Animal Ethics Committee, the IOP of both eyes of each rabbit were recorded with a Tonopen (Tono-Pen XL, Reichart Inc., Depew, NY, USA) after the application of topical proparacaine 0.5% HCl anesthesia. Blood (4 mL) was collected from the marginal ear vein and an intracameral injection of 2.3 mg/mL sodium hyaluronate and subconjunctival dexamethasone was given in the right eye. Anterior chamber aqueous fluid was obtained using a limbal approach with a 27 gauge needle from both eyes. The left eyes were used as controls. IOP was measured on the 1(st), 3(rd) and 10(th) day after the initial injection, with Tonopen, IMA-s levels and IMA-HA examined simultaneously. Before the injections, IOP was 11.4±3.0 mm Hg in the right eye and 11.3±3.1 mm Hg in the left eye (P>0.05). There was a statistically significant difference between IMA-s levels before the IOP increase (IMA-s0) and IMA-s levels on the 1(st) and 3(rd) days after the increase in IOP (P=0.012 and P=0.01, respectively). No difference was observed between IMA-s0 and serum IMA levels on the 10(th) day (IMA-s10) after IOP increase (P=0.989). IMA-HA in the right eye in the first day after the injection was positively correlated with IOP (r=0.748; P=0.02). No other correlation is found between any other parameter with IMA-HA levels at any test time. A statistically significant positive correlation was observed between IMA-s values and IOP on the 1(st) and 3(rd) days (r=0.398, P=0.04 and r=0.382, P=0.04, respectively). There was no correlation between IMA-s levels and increased IOP on the 10(th) day after IOP increase (r=0.026, P=0.902). IMA may be an important indicator of acute damage caused by diseases involving ischemic damage to the eye, especially in case of increased intraocular pressure.

Limbal vitrectomy of persistent hyperplastic primary vitreous with disappeared anterior chamber and corneal opacity

Objective To investigate the effects of limbal vitrectomy for persistent hyperplastic primary vitreous (PHPV) with disappeared anterior chamber and corneal opacity.Methods Sixteen eyes of 16 children with unilateral PHPV were included in this retrospective study.All the 16 eyes had both anterior and posterior disease,including opaque cornea,disappeared anterior chamber,pupil occlusion and extensive synechia,and lens opacity.The visual acuity was hand movement in 1 eye,and light perception in 15 eyes.There were 7 eyes with microphthalmia,4 eyes with total retinal detachment,3 eyes with retinal dysplasia,1 eye with retinal folds,and 4 eyes with high intraocular pressure preoperatively.All the eyes underwent limbal vitrectomy,including dissection of synechia,pupil formation,lensectomy,posterior lens membrane peeling and vitrectomy.Four eyes with retinal detachment received long-acting gas tamponade following vitrectomy.The mean follow-up was 15.8 months (range from 9 to 21 months).Results No eye had intraoperative complications.After surgery,all the 16 eyes had normal anterior chamber,round pupil and improved corneal transparency.Two eyes achieved a final visual acuity of 20/940 or better.Of the 4 eyes with retinal detachment,3 eyes achieved retinal reattachment.Of the 4 eyes with preoperative high intraocular pressure,3 eyes had controlled intraocular pressure postoperatively and the remaining 1 eye underwent glaucoma procedure at 6 months after the primary surgery.Conclusion PHPV eyes with disappeared anterior chamber and corneal opacity have a potential for developing better vision with improved cosmetic outcome and controlled intraocular pressure after vitrectomy by limbal approach. Key words: Persistent hyperplastic primary vitreous/therapy; Vitrectomy

Long-term Risk of Glaucoma After Congenital Cataract Surgery

To report the long-term risk of glaucoma development in children following congenital cataract surgery. Retrospective interventional consecutive case series. We retrospectively reviewed the records of 62 eyes of 37 children who underwent congenital cataract surgery when <7 months of age by the same surgeon using a limbal approach. The Kaplan-Meier method was used to calculate the probability of an eye's developing glaucoma and/or becoming a glaucoma suspect over time. The median age of surgery was 2.0 months and the median follow-up after cataract surgery was 7.9 years (range, 3.2-23.5 years). Nine eyes (14.5%) developed glaucoma a median of 4.3 months after cataract surgery and an additional 16 eyes (25.8%) were diagnosed as glaucoma suspects a median of 8.0 years after cataract surgery. The probability of an eye's developing glaucoma was estimated to be 19.5% (95% CI: 10.0%-36.1%) by 10 years after congenital cataract surgery. When the probability of glaucoma and glaucoma suspect were combined, the risk increased to 63.0% (95% CI: 43.6%-82.3%). Long-term monitoring of eyes after congenital cataract surgery is important because we estimate that nearly two thirds of these eyes will develop glaucoma or become glaucoma suspects by 10 years after cataract surgery.

Combined pars plana and limbal approach for removal of congenital cataracts

We describe a combined pars plana-limbal approach using a 25-gauge transconjunctival sutureless vitrectomy system for removal of congenital cataracts in a 5-month-old boy. The operated eye had anterior capsulotomy, lensectomy, posterior capsulotomy, and anterior vitrectomy through a pars plana transconjunctival incision created with a 25-gauge trocar. A limbal port incision was used to introduce an infusion micro cannula to maintain the anterior chamber. Incisions did not require suture closure. Following the procedure, inflammation was mild, the pupil was circular and centric, and the intraocular pressure (IOP) was stable. The eyes were left aphakic, and vision was corrected with spectacles. Amblyopia treatment ensued. This surgical technique appears to be safe and effective for the removal of congenital cataracts. Advantages include a more precise capsulotomy and more sufficient lensectomy and anterior vitrectomy, stable intraoperative IOP, and reduced surgical trauma and inflammation. No author has a financial or proprietary interest in any material or method mentioned.

Experience with Extra-capsular Cataract Exraction and Intra-ocular Lens Implant in Children

in developing countries congenital cataract has become an important cause of treatable blindness in childhood. However, difficulty in correcting aphakia is one of the reasons for poor visual outcome. to determine the visual outcome after extra capsular cataract extraction and intra ocular lens implant and factors militating against good visual outcome in children. a prospective interventional study of cataract extraction in children with intra ocular lens implant. Extra capsular cataract extraction with intra ocular lens implant was performed using the superior limbal approach. Polymethyl Methacrylate lenses were inserted. Posterior capsulotomy was done with a 25G needle bent at the tip in 26 eyes. thirty two eyes of twenty five children aged between 4 months and 16 years were operated. Extra capsular cataract extraction with posterior chamber intraocular lens implant was done in 27 (83.4%) eyes, plain extra capsular cataract extraction in 3 (9.4%) eyes, extra capsular cataract extraction with anterior chamber intraocular lens implant in 1 (3.1%) eye and vectis extraction in 1 (3.1%) eye. Twenty six eyes had primary posterior capsulotomy. Thirty-two (100%) eyes and 15 (60%) children were blind before surgery. Result of post operative visual acuity in 18 children after refraction was 6/18 or better in 4 (22.2%) children 6/24-6/60 in 11 (61.1%) and< 3/60 in 3 (16.7%) children. visual rehabilitation following extra capsular cataract extraction with Intra Ocular Lens Implant is encouraging in children.

Intraoperative conversion rate to a large, limbal opening in minimally invasive strabismus surgery (MISS)

To evaluate which factors predispose to an intraoperative conversion to the usual limbal approach in minimally invasive strabismus surgery (MISS). This study included 451 consecutive patients operated on by one surgeon at Kantonsspital St Gallen, Switzerland, with minimally invasive rectus muscle surgery between February 2003 and December 2007. We evaluated the intraoperative conversion rate to the usual limbal approach over time, and performed a retrospective determination of date of surgery, age of patient, motility of the eye, primary or revision surgery, and the type and dose of surgery in 982 consecutive rectus muscle procedures. In 3.6% (35/982) of MISS procedures, an intraoperative conversion to a large, limbal approach was necessary. The overall conversion rate decreased over time, from 8.4% in 2003 to 0.4% in 2007. The multivariate regression analysis showed a significant negative influence between the date of surgery and the conversion rate (p < 0.005). Muscle resections were associated with a higher conversion rate (p < 0.001). The other evaluated factors had no significant influence on an intraoperative enlargement of the conjunctival opening. This study confirms the reliability of the new MISS technique, and shows a low conversion rate to the usual limbal approach. The conversion rate decreased over time with increasing surgical experience. Muscle resections were associated with a higher conversion rate, while the age of the patient, the motility of the eye, revision surgery and the dose of surgery had no significant influence on an intraoperative conversion.

LARV: Limbal Approach Retropseudophakic Vitrectorrhexis and Vitrectomy– An Innovative Technique for the Management of Pediatric Cataract

Aim: To report safety and efficacy of LARV (Limbal Approach Retropseudophakic Vitrectorrhexis and Vitrectomy), an innovative technique for the management of Pediatric Cataract. Subjects and Methods: This descriptive caseseries included children undergoing IOL implantation with primary posterior capsulectomy and anterior vitrectomy for developmental or traumatic cataract with no other ocular co-morbidity. All the patients had hydrophobic IOL implanted in the bag followed by LARV performed by a pediatric ophthalmologist in the learning phase of this technique. On follow up, the patients were evaluated for 1) IOL position, 2) size and centration of the posterior capsulectomy, 3) adequacy of anterior vitrectomy and 4) complications. Results: 23 eyes of 18 consecutive patients, aged 4.5 ± 3.5 years with a mean follow up of 7.3 ± 4 months were included. 3 had traumatic cataract, 20 had developmental cataract and 13 were females. Ninety one % (21/23) had IOL in the bag, mean posterior capsulectomy size was 4.6 ± 0.9 mm, IOL was well centered and anterior vitrectomy was adequate in all. During the surgery, one patient had partial dislocation of the IOL behind the posterior capsule that needed IOL repositioning in the sulcus. One patient had one haptic in the anterior chamber that needed repositioning. Three patients had posterior synechia < 1 clock hour, 4 had pigmentation on the IOL optic. Conclusion: LARV is a useful technique for pediatric cataract albeit with a steep learning curve. Potential complications of LARV during the learning phase need awareness. A case–control study is needed to assess its advantages over conventional technique of pediatric cataract surgery.

Combined horizontal rectus muscle minimally invasive strabismus surgery for exotropia

Objective: To evaluate combined horizontal rectus muscle minimally invasive strabismus surgery (MISS) for exotropia. Design: Case series. Participants: Fifty-two consecutive exotropic patients operated on by 1 surgeon with MISS combined unilateral lateral rectus muscle recession and medial rectus muscle plication. Methods: Alignment, binocular single vision, conjunctival injection and swelling, and complications during the first 6 postoperative months were recorded prospectively. Conjunctival swelling and injection on the first postoperative day were scored retrospectively and compared with historic controls operated on with combined recession-plication or recession-resection using a limbal approach. Results: Conjunctival swelling and injection were mainly mild on the first postoperative day and less pronounced than after surgery with a limbal approach (comparison of swelling and injection for MISS vs limbal opening recession-plication p < 0.001 and for MISS vs limbal opening recession-resection p < 0.001). A conversion to a limbal approach was necessary in 3/104 (3%, 95% CI 1%–7%) of all muscles. No scleral perforation or other serious complication was observed, and no patient needed a repeat operation within 6 months (0/49, 0%, 95% CI 0%–6%). Conclusions: This study demonstrates that small-incision, minimal dissection combined recession-plication surgery induces less conjunctival swelling and injection compared with the usual limbal approach.

Missed intraocular foreign body masquerading as intraocular inflammation: two cases

To report two cases with missed intraocular foreign body masquerading as intraocular inflammation. The first patient was referred to our clinic with a diagnosis of a traumatic cataract. She had a history of ocular trauma. The clinical examination revealed intraocular inflammation and a mature cataract. Plain X-ray did not reveal a foreign body. She underwent a successful cataract surgery and intraocular lens implantation 1 month after the initial examination. Two months after the surgery she returned with visual impairment and intraocular inflammation. The foreign body was discovered on the surface of the iris during the follow-up. The second patient was referred to us for endophthalmitis. He denied ocular trauma. Plain X-ray, computerized tomography, and ultrasonography did not show a foreign body, but because of clinical suspicion, surgery was scheduled. In both patients the intraocular foreign bodies in the anterior chamber were removed successfully by a limbal approach. The patients remained symptom free after the foreign bodies were removed. The intraocular inflammation did not persist. A history of ocular trauma, unexplained intraocular inflammation, or intraocular inflammation unresponsive to the standard therapies should alert the physician to the presence of an intraocular foreign body. Further investigations should be performed in these cases to detect the foreign body.

Minimally Invasive Strabismus Surgery Technique in Horizontal Rectus Muscle Surgery for Esotropia

Purpose: To evaluate the minimally invasive strabismus surgery (MISS) technique in combined unilateral horizontal rectus muscle operations for esotropia. Methods: This study included 61 patients operated by one surgeon with MISS medial rectus muscle recession and lateral rectus muscle plication. Alignment, binocular vision, conjunctival injection and swelling as well as complications during the first 6 postoperative months were recorded prospectively. Conjunctival swelling and injection on postoperative day 1 were scored retrospectively and compared to a study, which included patients operated with a limbal approach. Results: Conjunctival swelling and injection were less pronounced than following surgery with limbal approach (comparison of swelling and injection: p < 0.001 for MISS vs. limbal opening plication and p < 0.001 for MISS vs. limbal opening resection). A conversion to a limbal opening was necessary in 2.4% of muscles. No scleral perforation or other serious complication was observed. Conclusions: This study indicates that MISS induces less conjunctival swelling and injection compared to the usual limbal approach.

Intraoperative performance and postoperative outcomes of cataract surgery in infant eyes with microphthalmos

To report the intraoperative performance and postoperative outcomes in microphthalmic eyes of infants younger than 1 year having bilateral cataract surgery. Iladevi Cataract & IOL Research Centre, Ahmedabad, India. This prospective observational study excluded eyes with ocular trauma, inflammation, posterior persistent fetal vasculature causing stretching of the ciliary processes or tractional retinal detachment, aniridia, or chorioretinal coloboma. Intraoperative observations included the rate of peripheral extension of the anterior capsule tear, intraoperative iris prolapse/trauma, and posterior capsule tear. All eyes were left aphakic. Postoperative observations included visual outcome, posterior synechias, visual axis obscuration (VAO), and glaucoma. The study evaluated 42 eyes of 21 infants. The mean age at surgery was 4.0 months +/- 2.6 (SD) and the mean follow-up, 25.6 +/-11.3 months. Surgery was performed using the limbal approach in 30 eyes (71.4%) and by pars plicata lensectomy in 12 eyes (28.6%). In the limbal group, 3 eyes (10.0%) had an incomplete anterior capsulorhexis, 2 eyes (6.7%) had iris trauma, and 2 eyes (6.7%) had peripheral extension of the posterior capsulectomy edge. At the final follow-up, visual acuity remained stable in 4 eyes (9.5%) and was improved in 38 eyes (90.5%). The complications were posterior synechias in 15 eyes (35.7%), glaucoma in 13 eyes (30.9%), and VAO in 7 eyes (16.7%). The results suggest that good visual outcomes can be obtained in microphthalmic patients with bilateral congenital cataract after early surgical intervention, with an acceptable rate of serious postoperative 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.

Paediatric cataract surgery

Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is non-progressive, while lamellar cataract usually develops later and is progressive. Prompt surgery has to be performed in cases with dense congenital cataract: if nystagmus has developed, the amblyopia is unfortunately irreversible. A treatment regime based on surgery within 2 months of life, combined with prompt optical correction of the aphakia and occlusion therapy with frequent follow-up, have been successful in both unilateral and bilateral cases. The surgery ought to include anterior and posterior capsulorexis in all children at the present time. Intraocular lens implantation has been safely performed below the age of 1 year and has also been successfully performed in bilateral cases. Anterior dry vitrectomy should be performed in preschool children to avoid visual axis opacification. Visual axis opacification is the most common complication found after cataract surgery in children. Secondary glaucoma is by far the most sight-threatening complication and is, unfortunately, common in the newborn so lifelong follow-up is essential in these cases.

Corneal ‘Dellen’ as a complication of strabismus surgery

This paper presents results of an analysis on patients operated on for strabismus in order to evaluate frequency and clinical characteristics of corneal alterations. In our experience, this kind of complication occurs more frequently after reoperation and/or after surgery for esotropia in sixth nerve palsy using transposition procedures. A retrospective analysis was made of 655 consecutive patients operated on for strabismus on the recti muscles with a limbal approach from January 2001 to July 2003 (30 months). We found 30 corneal dellen out of the 184 eyes (16.30%) reoperated on medial rectus muscles, 7 corneal dellen out of the 37 eyes (18.92%) operated on using transposition procedures, 4 corneal dellen out of the 101 eyes (3.96%) operated of lateral rectus muscle recession combined with medial rectus muscle resection and no corneal dellen in the other 976 eyes operated of using different surgical procedures on the recti muscles. All patients had been operated on using a conjunctival limbal approach. All corneal dellen disappeared in about 10-15 days, using topical antibiotics and a firm bandage applied to the eye at night, leaving permanent alterations in corneal homogeneity in 8 eyes (19.51%). This study showed that this kind of complication is relatively frequent after reoperations and/or transposition procedures, thus indicating that it is possible to identify surgical procedures which might play a role in the development of corneal dellen. Therefore, the post-operative monitoring of patients at risk should not be delayed for more than one week, in order to avoid possible corneal perforation.

Chirurgische Therapie der kongenitalen Katarakt

Due to the anatomical dimensions being smaller and the tissue structures being softer and more elastic in the young patient, surgery of paediatric cataracts represents a special challenge for the ophthalmic surgeon. Surgery is performed via a limbal or pars plana approach. The extreme high rate of secondary cataract formation in the paediatric or adolescent eye with closed posterior capsules is countered by means of complicated capsular surgery, special intraocular lens (IOL) implantation techniques, and vitreoretinal surgical procedures. It is customary not to implant IOLs before the children are 1-2 years old as increased axial length growth must be expected during the first 18 months after birth. IOL power is selected so that postoperative refraction is within the hyperopic range and with time, undercorrection will be balanced by bulbus growth. Preoperative and postoperative therapy is highly dependant on the extent of trauma sustained during surgery and should contain anti-inflammatory medication with and without steroids as well as antibiotics. Orthoptic follow-up examinations are also decisive for the long-term result.

Outcome of Early Surgery for Bilateral Congenital Cataracts in Eyes with Microcornea

To report the outcome of early surgery for bilateral congenital cataracts in eyes with microcornea. Interventional case series. We retrospectively reviewed 22 eyes of 11 patients with microcorneas who underwent early surgery for bilateral congenital cataracts. All patients underwent lensectomy and anterior vitrectomy via the limbal approach by 12 weeks of age. The corneal diameters at the time of surgery ranged from 7.0 to 9.0 mm. The mean age at the time of surgery was 7.7 +/- 3.3 weeks (range, two to 12 weeks); the follow-up period was 115 +/- 58 months (range, 40 to 199 months). Aphakic eyes were corrected with spectacles or contact lenses. Visual acuities and the postoperative complications were evaluated periodically. The morphologic types of cataract were nuclear (12 eyes), complete (eight eyes), and membranous (two eyes). Other preoperative ocular abnormalities included iris hypoplasia in 10 eyes and persistent fetal vasculature in three eyes. Systemic abnormalities were found in four patients. Postoperative complications occurred in 11 eyes (50%), including glaucoma (nine eyes), exudative retinal detachment (two eyes), rhegmatogenous retinal detachment, and secondary membrane formation, in one eye each. The binocular visual acuity was 20/40 to 20/20 in six patients (55%), 20/200 to 20/100 in two patients (18%), and 2/100 or worse in three patients (27%) who developed postoperative glaucoma. Despite microcorneas, favorable visual outcomes were achieved after early surgery in this series. However, adequate management of postoperative complications, especially glaucoma, is required.

Early surgery of bilateral congenital cataracts in eyes with microcornea

Purpose: To report the results of early surgery of congenital cataracts in eyes with microcornea. Methods: We retrospectively reviewed the charts of 22 eyes of 11 patients. All patients underwent limbal approach lensectomy and anterior vitrectomy within 12 weeks. The mean corneal diameter at surgery ranged from 7.0 to 9.0 mm. The mean age at surgery was 7.7 ± 3.3 weeks (range, 2-12 weeks); the follow-up period was 111 ± 59 months (range, 36-196 months). Results: Other preoperative ocular abnormalities included iris hypoplasia in 10 eyes and persistent fetal vasculature in 3 eyes.