Removal Of Congenital Cataracts Research Articles

Incidence and predisposing factors of intraocular Lens tilt following secondary ciliary sulcus implantation in children: An ultrasound biomicroscopic study.

To evaluate the incidence and causes of intraocular lens (IOL) tilt and changes in anterior chamber angle after secondary IOL sulcus implantation following congenital cataract removal. A retrospective observational study was conducted on children who underwent secondary sulcus IOL implantation following pediatric cataract removal in the period from 2017-2020 in Cairo university Hospitals. Children were examined for IOL position, centration, and tilt. Intraocular pressure (IOP) measurement, fundus and gonioscopic examination was performed. Ultrasound biomicroscopy (UBM) was performed on both eyes in children with clinically detected tilt. Ciliary sulcus secondary IOL implantation was performed in 102 eyes (57 children). IOL tilt was detected clinically in 16 eyes of 14 children (15.7%). UBM showed clinically undetected tilt in the fellow eye in additional 4 eyes. The mean angle of tilt was 12.8 ± 3.9° in clinically detected tilt compared to 7.5 ± 1.2° in UBM detected tilt. Mean anterior chamber depth (ACD) was 2.4 ± 0.5 mm IOP was >21 mmHg in 1.9% of eyes. Narrowing of the anterior chamber angle (ACA) after sulcus implantation occurred in 40% of eyes with open angle. Sulcus proliferations and obliterated sulcus were detected in all 20 eyes. Sommering's ring was found in 7 eyes (35%). Axial length, corneal diameter, and presence of persistent fetal vasculature did not affect IOL position. The presence of residual lens matter or an obliterated ciliary sulcus is associated with a higher incidence of IOL malposition following ciliary sulcus implantation.

Long-term functional outcomes after congenital cataract extraction with intraocular lens implantation in children of the first year of life

To study best corrected visual acuity (BCVA) and identify its relationship with various factors in eyes with pseudophakia in long-term periods after removal of congenital cataract (CC) in the first year of life. The study included 54 children (72 eyes) aged 4 to 12 years who had undergone CC removal with intraocular lens (IOL) implantation at the age of 2-11 months. Examination included: visual acuity testing, Flicker ERG 30 Hz electroretinography (MBN, Russia), optical coherence tomography (HRT-OCT) on the Heidelberg Spectralis (Heidelberg Engineering, Germany) platform. The best results were obtained after removal of bilateral congenital cataract (BCC): BCVA in 58.0% of cases was 0.15-0.3, and in 12.0% of cases - 0.4-0.8. BCVA was 0.1 or less in 95.5% of cases and only one child had 0.2 after removal of unilateral congenital cataract (UCC). The best BCVA was achieved in children operated on the 2-5 month of age (BCVA more than 0.3 in 68.7%; only children from that group had 0.5-0.8), without any concomitant pathology and with normal indicators of ERG Flicker 30 Hz. Deviations from physiological formation of the macula were revealed using OCT. The direct relationship was shown between BCVA, and the maximal retinal thickness in parafovea and choroidal thickness in the subfoveal area. BCVA significantly varies after CC removal with IOL implantation in infancy: 0.02-0.8. The main factors influencing BCVA in that case are: laterality of cataract, child age at the time of operation, duration of visual deprivation, concomitant eye pathology and refractive amblyopia accompanying incomplete correction of aphakia.

Glaucoma Surgery in Anterior Segment Dysgeneses

Anterior segment dysgeneses are rare conditions, and mostly occur sporadically. The severity of dysgenesis and the number of structures affected are highly variable. Glaucoma occurs in approximately 50% of all patients, either as part of primary chamber angle dysgenesis or secondary to surgery, mostly for removal of congenital cataracts. This review provides a brief overview of the embryological background and the spectrum of phenotypes, such as primary congenital glaucoma, Axenfeld Rieger and Peters Anomaly. Current surgical approaches to lower intraocular pressure are discussed. Special attention is paid to the increasingly used microcatheter-assisted 360° trabeculotomy and glaucoma drainage devices in paediatric glaucoma surgery.

The Results of Morphometric Assessment of the Macular Zone in Congenital Cataract

Purpose:to study the morphological characteristics of the macular zone using optical coherence tomography to assess its development in congenital cataract.Patients and methods:a comprehensive ophthalmological examination was performed in 147 children (269 eyes) aged 1 to 15 years, including, along with traditional methods, optical coherence tomography on the Spectralis HRA + OCT instrument, Heidelberg Engineering. Of these, 193 eyes were with pseudophakia after the removal of congenital cataracts in children aged 2 months to 14 years, 18 eyes with aphakia after the removal of congenital cataracts in children aged 2 months to 11 years, 20 unoperated eyes with partial forms of congenital cataracts and 38 paired conditionally healthy eyes in children with unilateral congenital cataracts. Visual evaluation of linear tomograms, measurement of 5 parameters of the central zone of the fundus and calculation of the macular index were performed.Results:various features of the macular zone were revealed: changes in the macular contour, lamellar structure of the retina, thinning of the choroid, and elements of epiretinal fibrosis. Evaluation of retinal differentiation with the help of a macular index, calculated on the basis of morphometric characteristics, revealed its violations in 52.8 % of cases, which was not always revealed in the visual analysis of tomograms. The best morphometric parameters of the central zone of the fundus are noted in the eyes with pseudophakia in comparison with aphakia (p < 0.05).Conclusion:there is a variability in the state of the macula. In patients with congenital cataracts. Better indicators of the central zone of the fundus in front of the eye with pseudophakia in comparison with aphakia justify the feasibility of performing surgical treatment of congenital cataracts simultaneously with the implantation of the intraocular lens, including in infants. Thinning of the choroid in the subfoveiolar zone with congenital cataract may indicate a violation of trophism and exert additional influence on the physiological development of the macular zone.

THE SURGICAL CORRECTION OF THE ANOMALIES OF THE POSTERIOR CAPSULE OF THE LENS

Aim. The objective of the present work was to describe the surgical strategy used for the correction of congenital cataract in the children presenting with the anomalies in the posterior capsule of the lens making possible intracapsular implantation of the IOL. Material and methods. The analysis of the surgical strategy for the removal of congenital cataract in the children presenting with the anomalies in the posterior capsule of the lens was performed based on the results of objective examination of its clinical and anatomical features in 40 patients (71 eyes) with the use of biomicroscopy, ophthalmoscopy, and ultrasound study. Results. The intact transparent posterior capsule of the lens was found in 28% of the examined children while 72% of them exhibited changes in the capsule in the form of thinning (33%), lenticone (25%), fibrous degeneration with the presence of calcificates (14%). The choice of the differential surgical treatment of the above anomalies was made on an individual basis. Implantation into the capsular bag proved successful in 81% of all the cases and into the ciliary furrow in 15%. Implantation of IOL was found impossible in $% of the patients. Due to a major defect of the capsular bag. Conclusion. The surgical treatment of congenital cataract with concomitant changes in the shape and transparency of the posterior capsule of the lens requires a differential approach in order to carry out intracapsular implantation of IOL even in the case of manifest posterior lenticone and avoid the development of intra- and postoperative complications.

Primary versus secondary intraocular lens implantation in the management of congenital cataract

Aim This study aimed to compare the efficacy of primary intraocular lens (IOL) implantation following removal of congenital cataract in patients with aphakia younger than 2 years of age, followed by secondary implantation after the age of 2 years. Patients and methods This was a comparative prospective study that included patients with congenital cataract (28 eyes) who underwent lensectomy and anterior vitrectomy in the first year of life; 14 eyes were subjected to primary IOL implantation. Fourteen eyes with left aphakia were subjected to visual rehabilitation until the age of 2 years. Secondary implantation was performed and the two groups were followed for 2 years after implantation by a full ophthalmological examination. Results Postoperative significant uveitis occurred in 14.2% of patients in group A and 35.7% of patients in group B; the difference between the two groups was statistically insignificant. Fixation was good in 71% of patients in group A and in 57% of patients in group B; this difference was nonsignificant. Increasing intraocular pressure was noted in four cases in group B that was statistically significant and the diagnosis of glaucoma was confirmed and managed, whereas in group A, none of the cases had an intraocular pressure higher than 18 mmHg. Conclusion Primary IOL implantation was found to be safe and effective in the management of congenital cataract; it leads to lower incidence of complications and better visual outcomes compared with aphakia and secondary IOL implantation.

Infantile Aphakic Glaucoma: A Proposed Etiologic Role of IL-4 and VEGF

To identify the factors secreted by lens epithelial cells (LECs) responsible for the altered trabecular meshwork (TM) cells and to compare their effect on monocultured TM cells with that of TM cells co-cultured with LECs. Such factors were isolated using cytokine antibody array membranes, and their effect on TM cells was assessed by analyzing changes in morphology and gene expression. In addition, inhibition of the isolated factors was performed in the co-culture model by adding specific antibodies to the cell culture media. Transforming growth factor beta-2, interleukin-4 (IL-4), and vascular endothelial growth factor (VEGF) are presented as candidate cytokines responsible for the observed changes in LEC-TM co-cultures. Culturing TM cells in the presence of VEGF and IL-4 triggered alterations closely reflecting those observed in the LEC-TM co-culture model, where their inhibition significantly hindered the alteration of the TM cells. These findings suggest a possible explanation for the development of infantile aphakic glaucoma, based on residual LECs secreting IL-4 and VEGF after removal of congenital cataract, which then alter trabecular meshwork cell morphology and gene expression.

Posterior capsulectomy using a 25-gauge microincision vitrectomy system for preventing secondary opacification after congenital cataract surgery: outcome up to 4 years

Objective: To assess long-term outcomes of posterior capsulectomy using a 25-gauge microincision vitrectomy system (25-GV) for preventing secondary visual axis opacification after congenital cataract surgery. Study Design: Retrospective noncomparative case series. Participants: Nine eyes of 5 children who underwent posterior capsulectomy carried out with the use of a 25-GV during congenital cataract surgery. Methods: After removal of congenital cataract with phacoemulsification and intraocular lens implantation, the posterior capsulectomy was performed using a 25-GV. Postoperative visual outcomes were analyzed. Results: The mean follow-up period was 43.11 (SD 5.53) months. Eight eyes maintained a clear visual axis, but 1 eye required Nd:YAG capsulotomy to enlarge the opening of the capsulectomy at 7 months postoperatively. Postoperative visual acuity was maintained up to 4 years without any other complications. Conclusions: Posterior capsulectomy using a 25-GV offers an option for preventing secondary visual axis opacifica-tion after congenital cataract surgery.

Intraocular lens movement and accommodation in eyes of young patients

Purpose To evaluate the position of posterior chamber intraocular lenses (PC IOLs) at distance and near and the amplitude of pseudoaccommodation in young eyes. Setting Department of Ophthalmology, University School of Medical Sciences, Bydgoszcz, Poland. Methods This study comprised 45 eyes of 38 patients aged 12 to 19 years who had removal of congenital cataract with implantation of a PC IOL. During the follow-up, the refractive error ranged between −1.00 and +1.00 diopter (D), and near visual acuity was 0.75 or 0.50 (Snellen) without additional correction. The position of the PC IOL was measured by A-mode ultrasound at distance and near. Pseudoaccommodation amplitude was calculated using Gullstrand’s near-point rule. Results Mean anterior movement of the IOL was 0.42 mm at near. Mean pseudoaccommodation amplitude was 4.50 D. The correlation between these values was significant ( P < .01). Conclusion The movement of PC IOLs in young patients may be one reason they attain good near vision without additional correction.

Rigid gas permeable contact lens correction of aphakia following congenital cataract removal during infancy.

Rigid gas permeable (RGP) contact lenses were prescribed and worn with little difficulty by 10 consecutive aphakic infants. Fluoroperm 92 lenses were used instead of silicone lenses (Bausch & Lomb) because of their lower cost, ease in handling, flexibility in design, and better neutralization of astigmatism. Lenses were worn on a daily wear basis (with occasional overnight wear) to reduce the risk of keratitis. Keratometry readings were taken at the time of surgery with the patient in a supine position. Trial lens fitting was performed 1 to 7 days later using a Burton Lamp. None of the patients developed keratitis, corneal neovascularization, or the sucked-on-lens syndrome. The lenses were well tolerated and the parents soon became adept at handling them. We now use RGP lenses as our lens of choice when treating aphakic infants.