Outcomes Of Pediatric Cataract Surgery Research Articles

Intraoperative challenges and outcomes of pediatric cataract surgery following glaucoma filtering surgery.

To analyze the intraoperative challenges of cataract surgery in children, following glaucoma filtering surgery. This was a retrospective study to analyze intra-op challenges and outcomes of pediatric cataract surgery in post-glaucoma filtration surgery eyes, between January 2007 and December 2019. We included 20 eyes of 16 children. The most common glaucoma surgery performed was trabeculectomy and trabeculotomy (14 eyes). The median age at the time of cataract surgery was 74.5months. The most common cataract surgery performed was lens aspiration with posterior chamber intraocular lens implantation (LA + PCIOL) (9/20). The most common intraoperative challenge faced was difficulty in capsulorrhexis (ten eyes), followed by extension of primary posterior capsulotomy (six eyes). At the final follow up eight eyes had improvement in visual acuity, five eyes had stable visual acuity and five eyes had a drop in visual acuity. In 12/20 eyes IOL was implanted, nine eyes in-the-bag and three eyes had in ciliary sulcus. None of the IOLs in the bag had decentration of IOL. The median postoperative IOP (p = 0.12) and median number of postoperative AGM (p = 0.13) at 2years remained stable compared to the preoperative values. The IOP remained well controlled in 4 eyes without anti-glaucoma medications and in 14 eyes with anti-glaucoma medications and none needed additional surgery for IOP control. Two eyes developed retinal detachment postoperatively. Cataract surgery in pediatric eyes with prior glaucoma surgeries, have challenges with capsulorrhexis and IOL stability. The visual outcomes were reasonably good so was the IOP control.

The Effects of Cataract Surgery on Children's Vision: A Systematic Review.

Five-fifths of all incidents of blindness in Saudi Arabia may be attributed to cataracts. Cataracts are the second major cause of blindness, responsible for 35.5% of cases. Therefore, the purpose of the research was to measure the visual acuity improvement after cataract surgery in children. This systematic review followed PRISMA guidelines for reporting systematic reviews. All procedures followed the recommendations of the Cochrane handbook. Studies of varying study designs, both published and unpublished, are included. Retrospective studies with outcomes of pediatric cataract surgery were identified from various databases. After an initial screening, 108 out of 167 items were deemed unsuitable for publication. There were 59 full-text papers assessed for inclusion, and only seven matched the criteria. All the articles included were of a very high standard. Both the duration of therapy and the target population varied widely between the studies. The results indicated that the majority of childhood cataracts are hereditary. Primary posterior capsulectomy and anterior vitrectomy combined with cataract extraction and intra-ocular lens implantation is the treatment of choice for pediatric cataracts. It is recommended that surgery be performed in a properly equipped facility staffed by trained, cooperative personnel and that different procedures be used to enhance post-operative follow-up.

Posterior Capsular Outcomes of Pediatric Cataract Surgery With In-The-Bag Intraocular Lens Implantation.

AimTo investigate the change of posterior capsular outcomes of pediatric cataract surgery with primary in-the-bag intraocular lens (IOL) implantation.MethodsWe conducted a case series of pediatric cataract children who underwent cataract extraction with primary in-the-bag IOL implantation, posterior capsulorhexis or vitrectorhexis, and limited anterior vitrectomy at the Eye Hospital of Wenzhou Medical University between 2016 and 2019. Digital retro-illumination photographs of pediatric eyes were obtained at baseline and 6 months, 12 months, and the last visit postoperatively. Capsular outcomes of the posterior capsular opening area (PCOA) and lens reprolifration area at those time points were compared. Correlations between the PCOA and influential factors, such as age at surgery, axial growth, and follow-up duration, were analyzed. The study was registered at register.clinicaltrials.gov (NCT04803097).ResultsData of 23 patients (27 eyes) were used in the final analysis. During follow-up, the PCOA enlarged at a rate of 0.29–0.32 mm2/month during the first six months postoperatively and 0.05–0.08 mm2/month over the next 1–2 years. Six months postoperatively, the PCOA enlargement statistically and positively correlated with the follow-up duration and axial growth. The area of lens reprolifration was 0.46 ± 1.00 mm2 at six months postoperatively and then remained stable.ConclusionThe PCOA enlarged rapidly within the first six months after the pediatric cataract surgery with primary IOL implantation. Six months postoperatively, the enlargement of PCOA was positively correlated with follow-up duration and axial growth. Posterior capsulorhexis or capsulectomy should be performed with a diameter of 3.0 to 4.0 mm for good visual axis transparency and the protection of in-the-bag IOL.

North India Childhood Cataract Study - The real scenario and causes of surgical delay of pediatric cataract.

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.

Outcome of pediatric cataract surgery with intraocular injection of triamcinolone acetonide: Randomized controlled trial.

To evaluate the use of intraocular injection of triamcinolone acetonide in pediatric cataract surgery with or without intraocular lens implantation as a vitreous dye to ensure a complete anterior vitrectomy and evaluate its effect on postoperative ocular inflammation, infection, posterior capsule opacification, and intraocular pressure. Randomized controlled trial included children diagnosed with bilateral congenital cataract in both eyes. Their eyes were randomly assigned into two groups: group A underwent aspiration, posterior capsulotomy, and anterior vitrectomy with intraocular injection of triamcinolone acetonide, while group B underwent the same surgical procedure without intraocular injection of triamcinolone acetonide. Intraocular pressure, postoperative inflammation, infection, and posterior capsule opacification were followed up till 6 months. The study comprised 44 eyes of 22 children. The mean age was 2.4 ± 2.1 years including 10 males and 12 females. The mean postoperative intraocular pressure was within normal range in both groups. No case of infection in both groups. No eyes in group A showed reaction, while in group B, three eyes showed exudate on the first day, which improved at 2 weeks. Posterior synechiae was recorded in four eyes in group A and in five eyes in group B. Posterior capsule opacification was noted in one eye in group A at 3 month, while it was noted in nine eyes in group B. The difference was statistically significant ( p = 0.004). Triamcinolone acetonide was found to be useful in better visualization of vitreous in pediatric cataract surgery and has good effect in decreasing postoperative inflammation and posterior capsule opacification.

Factors affecting the visual outcome of pediatric cataract surgery: a hospital based prospective study in eastern Nepal.

The World Health Organization's (WHO) global initiative for the elimination of avoidable blindness by the year 2020 (Thylefors et al., 1995) has prioritized the control of childhood blindness. Currently cataract remains one of the most important causes of treatable blindness in children (Giles et al., 2016). In Nepal, as in other developing countries, cataract is believed to be a leading cause of blindness in children. According to The Nepal Blindness Survey from 1978 to 1980, congenital cataract accounted for 16.3% of blindness detected in children under the age of 15 years (Brilliant et al., 1985). Epidemiology of Blindness in Nepal 2012 survey has suggested that the prevalence of childhood blindness has reduced from 0.68% in 1981 to 0.4% in 2011 (Sapkota, 2012).

Outcome of Pediatric Cataract Surgeries in a Tertiary Center in Switzerland.

Purpose To determine and to analyze the outcome of pediatric cataract surgery. Methods A retrospective chart review of individuals aged up to 10 years who underwent cataract surgery between January 1, 2004, and December 31, 2014, at the UniversityHospital Zurich, Switzerland. Results 63 children (94 affected eyes) with bilateral (68/94) or unilateral (26/94) cataract were identified. Surgery was performed at a median age of 1.5 months (IQR: 1.3–2.6 months) for the aphakic group (45/94) and of 50.7 months (IQR: 38.0–78.4 months) for the IOL group (49/94). At the last follow-up visit (median 31.1 months, IQR: 18.4–50.2 months), visual acuity was better in bilateral than in unilateral cataract cases. Posterior capsular opacification (PCO) was diagnosed in 30.9% of eyes without a significant difference in the IOL and aphakic groups (p = 0.12). Aphakic glaucoma was diagnosed in 12/45 eyes at a median of 6.8 months (IQR 2.1–13.3 months) after surgery. Microcornea (5/12) and anterior segment anomalies (8/12) were associated with glaucoma development (p < 0.05). Conclusion Laterality and timing of surgery influence the outcome of pediatric cataract surgery. PCO was the most frequent postoperative complication. Aphakic glaucoma is often associated with ocular developmental abnormalities and a poor visual outcome.

Pediatric cataract surgery outcomes in Kano, Nigeria

Objective: To report the outcomes of pediatric cataract surgery over a 7-year period in a mission hospital in northern Nigeria. Patients and Methods: We retrospectively examined the notes of 230 consecutive children aged 16 years and younger, who underwent bilateral cataract surgery by a single surgeon. The patients’ demographic, preoperative, and postoperative clinical details were analyzed. Details regarding the eye with the better postop vision were used in the analysis. Results: A total of 230 patients were included, of which 148 (64.4%) were boys. Age at presentation ranged from 1 month to 16 years, with a mean of 4.89 years and standard deviation of 4.21 years. Median delay for presentation was 12 months, with an interquartile range of 4–36 months. Visual acuity at presentation in the selected operative eye was normal in 2 (0.91%) patients and blind in 179 (81.4%) patients. Best-corrected postop vision was normal in 63 (31.5%) patients, visually impaired in 62 (31.0%) patients, severely visually impaired in 23 (11.5%) patients, blind in 52 (26.0%) patients, and not recorded in 30 (13.0%) patients. A total of 114 (49.8%) patients were prescribed glasses. Median follow-up was 1 month (interquartile range 0.5–3 months). Conclusion: Although a majority of the children were blind in the operative eye prior to surgery, over a quarter achieved normal vision after surgery. Factors that may improve outcomes in this setting include prescribing glasses to all and facilitating increased follow-up.

Outcome of Pediatric Cataract Surgery in Patients Who Have Undergone Bone Marrow Transplantation

Purpose: Bone marrow transplantation (BMT) and pre-treatment conditioning increases the risk of developing pediatric cataracts. We present the outcome of cataract surgery in children who have had BMT. Methods: We conducted a retrospective chart study with 15 BMT patients (28 eyes) who underwent cataract extraction between 2002 and 2012. Outcome measures include change in best corrected visual acuity (BCVA) and complications. Results: 7 (47%) patients had acute lymphoid leukemia, 3 (20%) had acute myeloid leukemia, 2 (13%) had myelodysplastic syndrome, 1 (7%) had Fanconi anemia, 1 (7%) had juvenile myelomonocytic leukemia, and 1 (7%) had adrenoleukodystrophy. Patients received BMT at a mean age of 3.9 ± 1.6 years. 12 (80%) patients received total body irradiation (TBI) and 3 of these 12 received cranial irradiation in addition to TBI; one (7%) received only cranial irradiation. Total body irradiation included head and eye exposure. Mean age of cataract surgery was 9.1 ± 2.3 years; mean follow-up was 55.9 ± 45.1 months. All cataracts were of posterior subcapsular subtype. Mean BCVA improved from 0.7 ± 0.4 logMAR to 0.3 ± 0.5 logMAR (p

Postoperative Refractive Errors Following Pediatric Cataract Extraction with Intraocular Lens Implantation

ABSTRACTPurpose: Advances in surgical techniques allow implantation of intraocular lenses (IOL) with cataract extraction, even in young children. However, there are several challenges unique to the pediatric population that result in greater degrees of postoperative refractive error compared to adults. Methods: Literature review of the techniques and outcomes of pediatric cataract surgery with IOL implantation. Results: Pediatric cataract surgery is associated with several sources of postoperative refractive error. These include planned refractive error based on age or fellow eye status, loss of accommodation, and unexpected refractive errors due to inaccuracies in biometry technique, use of IOL power formulas based on adult normative values, and late refractive changes due to unpredictable eye growth. Conclusions: Several factors can preclude the achievement of optimal refractive status following pediatric cataract extraction with IOL implantation. There is a need for new technology to reduce postoperative refractive surprises and address refractive adjustment in a growing eye.

The Outcome of Pediatric Cataract Surgery in Sohag University Hospital

The Outcome of Pediatric Cataract Surgery in Sohag University Hospital

Outcomes of pediatric cataract surgery with triamcinolone-assisted vitrectomy.

To evaluate outcomes in pediatric patients undergoing lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy for congenital cataract. This retrospective study included 34 patients younger than 72 months who underwent lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy with or without intraocular lens (IOL) implantation for cataract at the National Taiwan University Hospital from July 2006 to December 2012. Fifty-one eyes from 34 patients with cataract (unilateral in 17 patients, bilateral in 17 patients) were included. The mean age at surgery was 26.74 months (range: 2-72 months). The mean postoperative follow-up was 27.8 months (range: 6-72 months). Primary IOL implantation was performed in 25 eyes, 21 of which had the IOL implanted in the capsular bag. Fifty eyes had a central round pupil. The median logarithm of the minimum angle of resolution visual acuity was 0.3 in patients with unilateral cataract and 0.1 in those with bilateral cataract. Three eyes (5.9%) developed visual axis opacification (VAO) and required further surgery. Univariate analysis using Fisher's exact test indicated that surgery in the first 12 months of life was significantly associated with development of VAO (p=0.047). The incidence of postoperative VAO was approximately 15.8% in this age group. Triamcinolone-assisted vitrectomy can be used in pediatric cataract surgery without serious long-term adverse effects. While the incidence of VAO is low, it appears unavoidable in approximately one-sixth of patients who undergo surgery before 12 months of age.

Outcomes of Pediatric Cataract Surgery in the Copperbelt Province of Zambia.

To study the outcomes of pediatric cataract surgeries in children operated on in the Copperbelt Province of Zambia and the barriers to accessing surgery. All children who had congenital, developmental, and traumatic cataracts operated on by lens aspiration, primary posterior capsulotomy, and anterior vitrectomy with posterior chamber intraocular lens implantation from 2012 to 2013 and followed up beyond 6 months were studied. Each child underwent a comprehensive preoperative evaluation. An active, assisted follow-up was done and parents were asked about reasons for delay between presentation and surgery. One hundred two eyes of 70 children met the inclusion criteria of the study. Preoperatively, 76 of 77 (98.7%) eyes in the congenital and developmental cataract group had presenting visual acuity of worse than 6/60. This improved postoperatively, with 19 (29.7%) eyes having best corrected visual acuity (BCVA) of better than 6/18, 23 (35.9%) having BCVA of 6/24 to 6/60, and 22 (34.4%) having BCVA of worse than 6/60. Older age (P = .005), better preoperative vision (P = .045) at presentation, unilaterality (P = .012), and delay between presentation and surgery (P = .004) were predictors of a better postoperative outcome. On multivariate analysis, only age was significant (P = .025). Distance and cost of travel and surgery were the causes of delay in presentation. In the patients with traumatic cataracts, 17 of 25 (68%) had BCVA of better than 6/18, 6 (24%) had BCVA between 6/24 and 6/60, and 2 (8%) had BCVA of worse than 6/60 at the 6-month follow-up. The most common causes of injury were being struck by sticks and stones (10 children, 25%). Visual outcomes after pediatric cataract surgery in Zambia were comparable and satisfactory. Cost of treatment was a barrier, but delay did not adversely affect outcome. [J Pediatr Ophthalmol Strabismus. 2016;53(5):311-317.].

Pediatric Cataract Surgery and Intraocular Lens Implantation with and without Intracameral Triamcinolone Acetonide

Purpose: To evaluate the safety and efficacy of a single intracameral injection of triamcinolone acetonide in controlling postoperative ocular inflammation and improving the outcome of pediatric cataract surgery with intraocular lens implantation. Setting: Prospective interventional comparative Quasi study. Patients and methods: The study was performed on eyes of children between 6-12 years old having significant cataract and subjected to cataract extraction with primary IOL implantation. Patients were divided into two almost equal age and sex matched groups. The study group included eyes that received intracameral injection of 4 mg/0.13 ml of preservative-free triamcinolone acetonide at the end of surgery while the control group included eyes that did not receive intracameral injection of triamcinolone acetonide. Postoperative examinations were done on day 1 then weekly for 1 month, and monthly for another 2 months. Primary outcome measures included any sign of anterior segment inflammation, while secondary outcome measures included best corrected visual acuity, intraocular pressure and any reported complication caused by intracameral triamcinolone acetonide. Results: The study included 42 eyes (35 patients); 21 eyes in each group. Postoperative inflammatory membrane was statistically significant higher in the control group than in the study group (P=0.018). The mean duration of using topical steroids in the study group (17.2 ± 4.1 days) was statistically significant less than its mean duration (28.3 ± 3.4 days) in the control group (P<0.05). No statistically significant differences were detected between pre and postoperative intraocular pressure in each group and in between both groups. No significant complications related to intracameral triamcinolone acetonide were reported. Conclusion: A single intracameral injection of 4 mg preservative free triamcinolone acetonide at the end of uncomplicated pediatric cataract surgery could be an effective and safe adjunct to postoperative topical steroids in controlling postoperative ocular inflammation.

Outcomes of Pediatric Cataract Surgery Under Local Anesthesia in a Rural Setting

Purpose To compare the surgical outcome visual acuity and complication rates among pediatric patients undergoing cataract surgery under local or general anesthesia in rural southern Ethiopia Methods This retrospective study included pediatric patients younger than years who underwent cataract surgery in rural southern Ethiopia during July August Local anesthesia was use in patients over the age of years unless they suffered from traumatic or bilateral cataract Clinical indices were collected before and following surgery including uncorrected visual acuity categorized into ambulatory better than hand motion and non ambulatory hand motion or light perception vision intraocular pressure cycloplegic refraction and ocular complications Results Ninety one eyes of consecutive patients male female were included in the study The average age at diagnosis was plusmn years Fifty five operations were performed under general anesthesia GA and using local anesthesia LA The percentage of patients with ambulatory UCVA improved significantly in both the GA vs p lt and LA groups vs lt No significant differences between the groups were noted regarding visual acuity results or complications Conclusions Our results suggest that the outcomes of pediatric cataract surgery performed under either local or general anesthesia were comparable LA should be considered a valid option for older children undergoing cataract surgery especially when medical resources are limited

Management Options in Pediatric Cataract

Pediatric cataract surgery remains a very important and difficult problem to manage and involves a team effort, the most important members of which are parents. While dramatic advances have occurred in this field during the past 10 years, some technical aspects of surgery, changing refraction, and functional outcome continue to pose significant problems. Manual capsulorhexis remains the gold standard for a successful outcome of pediatric cataract surgery as well as in deciding intraocular lens (IOL) placement. Primary management of the posterior capsule with or without anterior vitrectomy is mandatory depending on age of the child at surgery. Primary implantation of the IOL after cataract removal is gaining popularity, even for infants and young children. Predicting axial growth and the refractive change that accompanies it is one of the major challenges for the long-term care of children after surgery. The evaluation of rate of axial growth and its correlation with age at surgery, laterality, aphakia/pseudophakia, and visual axis obscuration is a positive step in this direction. Finally, appropriate visual rehabilitation and amblyopia therapy are the cornerstones for the child’s final visual development.

Comparison of hospital versus rural eye camp based pediatric cataract surgery

Purpose:To compare the outcomes of pediatric cataract surgery with intraocular lens (IOL) implantation in an eye camp setting and tertiary care center.Materials and Methods:Children aged 5-16 years with visually significant cataract underwent phacoaspiration with IOL implantation in an eye camp (eye camp group) or tertiary care center (TCC group). All surgeries incorporated contemporary microsurgical techniques with implantation of polymethyl-methacrylate (PMMA) IOL. Major postoperative complications were managed at a tertiary care center. Postoperative complications, visual acuity and compliance were evaluated using the Chi-square test. A P value less then 0.05 was considered as statistically significant.Results:The cohort comprised 59 children in the eye camp group and 48 children in the TCC group. Thirty two of fifty nine (54.23%) eyes in the eye camp group and 30/48 (62.5%) eyes in the TCC group achieved 20/40 or better best corrected visual acuity (BCVA) postoperatively. Postoperatively, 36 (61%) eyes in the eye camp group and 22 (45.83%) eyes in the TCC group required Nd: YAG laser capsulotomy or a pars plana membranectomy. (P> 0.05) The most striking feature was loss to follow up. In the eye camp group, loss to follow was 20% at one year, 49% at two years, 62% at 3 years and 67% at 4 years compared to 12.5, 21, 27 and 33% respectively in the TCC group (P<0.05, all cases).Conclusions:The outcomes of camp and tertiary care center (hospital) based pediatric cataract surgery were similar. However, the major drawback of camp based surgery was loss to follow up which eventually affected the management of amblyopia and postoperative complications.

Outcomes of Pediatric Cataract Surgery at a Tertiary Care Center in Rural Southern Ethiopia

To evaluate the etiologies, management, and outcomes of pediatric cataracts in a rural sub-Saharan African setting. A retrospective, consecutive case series of patients presenting to a tertiary referral center in southern Ethiopia during a 13-month period. All patients underwent clinical examination, were diagnosed as having cataract on the basis of standard clinical assessment, and immediately underwent surgical management. Visual acuity results were grossly divided into ambulatory and nonambulatory vision according to patient age and cooperation. Ninety-one eyes of 73 consecutive patients (57 boys and 16 girls) were included in the study. The mean (SEM) age at diagnosis was 7.1 (0.5) years (range, 0.5-15 years). Fifty-five patients had unilateral cataract and 18 had bilateral cataract. Cataracts were categorized according to the etiologic cause: congenital (n = 50), traumatic (n = 33), congenital glaucoma-related (n = 3), partially absorbed cataracts (n = 3), and congenital rubella infections (n = 2). At presentation, visual acuity ranged from 6/60 to light perception, with 13 eyes (14%) having ambulatory vision (better than hand motion). The mean postoperative visual acuity was significantly improved, ranging from light perception to 6/9. Seventy-five eyes (82%) achieved ambulatory vision. Of the 61 eyes with an implanted intraocular lens, 56 (92%) reached ambulatory visual acuity following surgery. This was significantly greater than preoperative visual acuity results (P < .001). The underlying cause and management of pediatric cataracts in the developing world can differ significantly from that commonly reported in the literature. The effects of appropriate intervention on both visual outcome and associated survival statistics may be profound.

Clinical Characteristics and Early Postoperative Outcomes of Pediatric Cataract Surgery With IOL Implantation From Lahan, Nepal

To report clinical characteristics and early postoperative outcomes of pediatric cataract surgery with intraocular lens (IOL) implantation from Lahan, Nepal. Demographics and surgical, preoperative, and postoperative clinical characteristics data were collected and analyzed. Of 2,633 eyes with primary IOL implantation, 2,003 eyes were in the non-traumatic group, whereas 630 eyes were from trauma. Median age at surgery was 7 and 9 years in the non-traumatic and traumatic groups, respectively. Boys comprised 74.2% of the non-traumatic and 85.4% of the traumatic cataract patients. Unilateral cataracts accounted for only 7.7% (154 of 2,003) of the non-traumatic group. Average follow-up was 35 days with greater than 6 months follow-up in 134 of 2,633 (5.1%) eyes. Most (68.5% [1,804 of 2,633]) of the lens opacities were described as total cataract. Although early postoperative best-corrected visual acuity improved from the preoperative recording in 95.0% (2,495 of 2,626) of eyes, 78.1% (2,050 of 2,626) remained in the poor (20/100 or worse) category. Median preoperative and early postoperative best-corrected visual acuity was hand motions and 20/200, respectively. A high-volume cataract surgical center in Lahan, Nepal, is able to provide cost-effective and high-quality pediatric surgery. Most of the patients in this series were noted to have complete cataracts and were boys. Visual improvement was achieved, but excellent visual outcomes were rarely documented due to late referral and inadequate follow-up. Educating families and primary caregivers with regard to the importance of earlier referral and postoperative optical correction and tracking will improve outcomes.

Update on bimanual microincisional cataract surgery

The purpose of this article is to highlight the major issues associated with bimanual microincisional cataract surgery and to review the recent literature addressing this subject. Bimanual microincisional cataract surgery has been performed successfully using all of the major phacoemulsification platforms. Technological advances in ultrasound power management and fluidics have improved the safety profile and efficiency of this technique. New intraocular-lens designs and surgical maneuvers permit intraocular-lens insertion through corneal incisions measuring 2 mm or less. Clinical results achieved with bimanual microincisional cataract surgery and new microincision lenses are comparable to those obtained with conventional coaxial phacoemulsification and established intraocular lenses. Bimanual microincisional cataract surgery is a promising surgical technique that continues to grow as phacoemulsification technology and intraocular-lens designs evolve.