Visual Axis Opacification Research Articles

This issue of ACTA

This issue of <i>ACTA</i>

Outcome of Paediatric Cataract Surgery at Tilganga Institute of Ophthalmology, Nepal

Introduction: Paediatric cataract and aphakia are still a major cause of childhood blindness in developing world due to lack of advanced technology. In developing countries like Nepal, many children still present late due to lack of awareness and financial constraints.Objectives: The objective of this study was to determine the outcome of paediatric cataract surgery in a tertiary eye care centre in Nepal.Methodology: A hospital based prospective, observational study taking 42 patients (77 eyes) aged ≦15 years diagnosed with paediatric cataract were enrolled during a period of 1 year ( Jan 2011 - Jan 2012) at Tilganga Institute of Ophthalmology, Kathmandu, Nepal. The patients underwent either: a) Lens aspiration + Primary posterior capsulotomy (PPC) + Anterior Vitrectomy; b) Lens aspiration + PPC+ Anterior Vitrectomy + Intra-ocular lens (IOL); c) Lens Aspiration + IOL. Post-operatively optical ± amblyopia correction. Statistical analysis was carried out by using STATA 9.0. The association of changes in the vision of eyes before and after surgery was analyzed by using generalization of McNemar's test (Stuart-Maxwell test). A pvalue of &lt; 0.05 was considered for the statistical significance. Institutional Ethics Board approval was obtained from the institutional review committee (IRC) of National Academy Medical Sciences ( NAMS ).Results: Mean age of patients was 4.46 yrs ± 4.32(SD), range from (15 days -12 yrs); Male : Female: 22 (52%)/20 (48%); 35 (83%) patients had bilateral cataract and 7(17%) had unilateral cataract. Morphologically, the most common type of cataract was total cataract (27/32%). Post-operatively, a statistically significant improvement in vision was there in all the eyes ( p value : &lt; 0.0001) . Visual axis opacification was the most common post- operative complication seen in 20(26% ) of total eyes by the end of 6 months.Conclusion: Good visual outcome in paediatric cataract surgery can be obtained in developing countries like Nepal with minimal intra and post-op complications. BJHS 2018;3(1)5 : 331-337

Clinical analysis on the efficacy of primary intraocular lens implantation in monocular pediatric congenital cataract of young children

Objective To analyze clinical efficacy of primary intraocular lens (IOL) implantation in monocular pediatric congenital cataract children of young. Methods The data of 17 children with 7 months-2 years old congenital cataract were collected and all cases received lens extraction combined with primary IOL implantation. The efficacy, complications and visual acuity after worn glasses and occlusion therapy were retrospectively analyzed. Results The follow-up time was 12-40 months. At the end of follow-up, the BCVA < 0.1 were in 8 cases (47.16%), 0.1-0.3 in 3 cases (17.64%), 0.4-0.5 in 4 cases(23.53%), and 0.6-0.7 in 2 cases (11.76%), respectively. Second surgery was performed in 3 cases (17.64%). Among them, visual axis opacification occurred in 1 case and occlusion of the pupil in 2 cases. One case with hyphema was aborted after medicine treatment. Glaucoma was diagnosed in 3 cases (17.64%) and suspected glaucoma in 2 cases (11.76%). Conclusion Lens extraction combined with primary IOL implantation is a safe and effective method for monocular pediatric congenital cataract of young children. Key words: Cataract, congenital, monocular, young children; Implantation, lens, intraocular, primary

Phacoemulsification and primary implantation with bag-in-the-lens intraocular lens in children with unilateral and bilateral cataract.

To report outcome in a paediatric cohort with cataract extraction and implantation of bag-in-the-lens intraocular lens (BIL-IOL). Children younger than 16years of age subjected to phacoemulsification with primary implantation of BIL-IOL during 2009 through 2013 were analysed retrospectively. Exclusion criteria were uveitis or ≤6months of follow-up. In total, 109 eyes of 84 children were included; 40 unilateral and 44 bilateral cataracts. For all eyes, median age at surgery was 2.5years (range 2weeks to 14.1years) and 16 children (24 eyes) were ≤6weeks. Coexisting systemic disease was more common in children with bilateral cataract (24 patients, 54.5%) compared to unilateral cataract (6 patients, 15.0%, p<0.0001). Ocular comorbidity was more common in unilateral cataracts; n=14 eyes (35.0%) compared to bilateral cataracts; n=10 eyes (14.5%; p=0.017). Median follow-up was 2.8years (range 7months to 5.8years). During the follow-up period, 15 (13.8%) eyes developed glaucoma and five (4.6%) eyes required treatment for visual axis opacification (VAO). Corrected distance visual acuity (CDVA) for bilateral cataracts at last follow-up was 0.42±0.45 (logMAR; mean±SD) with 35 (55.6%) eyes attaining a CDVA of ≥0.5 (dec). For unilateral cataracts mean CDVA was significantly poorer; 0.67±0.51 (p=0.010) with 15 (37.5%) eyes attaining a CDVA of ≥0.5. For children having cataract surgery with primary implantation of BIL-IOL, VAO is rare and visual outcome overall good. Unilateral cataracts are associated with a higher proportion of ocular comorbidity and poorer visual outcome.

Long-term outcomes following primary intraocular lens implantation in infants younger than 6 months

Purpose:To study the long-term safety profile and visual outcomes of primary intraocular lens (IOL) implantation in infants <6 months of age.Methods:This was a retrospective observational study conducted at a tertiary eye care center in South India. Infants under 6 months meeting the selection criteria who underwent cataract surgery (lens aspiration, primary posterior capsulorhexis, and anterior vitrectomy) with primary IOL implantation between January 2008 and December 2011 and minimum 3-year follow-up were included. Patient demographics, serial refractions, visual acuity, complications, and associated amblyopia/strabismus were reviewed. Visual acuity, myopic shift, and complications were the outcome measures.Results:Sixty-nine eyes of 38 infants (31 bilateral; mean age: 4.6 months) were reviewed. Mean follow-up was 51 months (range: 36–84). Median logMAR best-corrected visual acuity at the final visit was 0.74 (interquartile range [IQR]: 0.50–0.98) in eyes with bilateral cataracts and 0.87 (IQR: 0.60–1.14) in eyes with unilateral cataracts with an average myopic shift of 6.7 diopters over 4.2 years. Most common postoperative complication was visual axis opacification (VAO) (13 eyes, 18%), necessitating membranectomy followed by pigmentary IOL deposits (11 eyes, 15%), and IOL decentration and glaucoma in four eyes each (5.6%). Mixed linear effect model found no significant association of age, gender, laterality, and postoperative complications with final visual acuity (P ≥ 0.05). Eyes with unilateral cataracts had a greater myopic shift than bilateral cases (P = 0.03).Conclusion:Primary IOL implantation in infants <6 months is reasonably safe in appropriately selected infants. VAO was the most common postoperative complication, and a large myopic shift was observed.

Comparing the outcome of intraocular lens implantation with or without posterior optic capture in pediatric cataract surgery

Purpose To evaluate the outcome of intraocular lens (IOL) implantation with posterior optic capture versus in-the-bag implantation in pediatric cataract surgery. Setting Ain Shams University Hospital and Research Institute of Ophthalmology. Design It is a prospective, comparative clinical study. Patients and methods Thirty eyes with developmental cataract underwent primary cataract extraction and IOL implantation of hydrophobic acrylic multipiece Sensar IOL AR40e. In all cases, anterior and posterior continuous curvilinear capsulorrhexis, lens aspiration, and anterior vitrectomy were performed. IOL was implanted in the ciliary sulcus, and the optic was captured in both anterior and posterior capsulorrhexis in group A (15 eyes) and implanted in the bag without capture in group B (15 eyes). Visual acuity, visual axis opacification, red reflex, intraocular pressure, centration, and complications were all assessed. Results The mean age of children was 5.3±2.93 years. At 6 months of follow-up, the mean postoperative corrected distant visual acuity was 0.69±0.19 and 0.65±0.23 in groups A and B, respectively. The mean clear central zone was 4.29±0.24 and 3.6±0.55 mm in groups A and B, respectively (P=0.001). The mean IOL decentration measured in mm was 1.61±1.17 and 0.86±0.28 SD in groups A and B, respectively (P=0.003). There were no postoperative complications in all cases. Conclusion Placement of IOL haptics in the ciliary sulcus while capturing the optic through the posterior continuous curvilinear capsulorrhexis provides more central clarity of the visual axis, however IOL decentration was more common.

PD78 Minimally Invasive Capsulorhexis In Children's Cataracts

Introduction:Minimally invasive capsulorhexis is an incision in the anterior capsule in the peripheral zone for cataract extraction. It allows reduction of the size of the lesion, ensuring a better transparency of the visual axis, preserving the capsule almost intact and a layer of lenticular epithelial cells. The procedure could have a potential regenerative effect of the lens in a natural way. The objective of this study is to assess the efficacy and safety of minimally invasive capsulorhexis to promote lens regeneration in children's cataracts.Methods:This technology was identified by the early Awareness and Alert System, “SINTESIS-new technologies” of Agencia de Evaluación de Tecnologías Sanitarias (AETS) Instituto de Salud Carlos III (ISCIII). An early assessment was conducted. The searched databases were: PubMed, Centre for Reviews and Dissemination (CRD), and Cochrane Library. Clinical studies using the procedure published in any language until 29 September 2017 were reviewed.Results:An open-label, randomized trial in pediatric cataract patients (age: 0–2 years) was retrieved. Twelve patients underwent minimally invasive capsulorhexis, while twenty-five patients received the standard treatment. Regarding efficacy, a transparent regenerated biconvex lens was found in 100 percent of eyes three months after surgery, but wasn't found in the control group. 100 percent of capsular openings healed within one month after surgery in the experimental group, but not in the control group. Both groups increased their visual acuity parameters without significant differences. Regarding safety, children receiving the standard technique had a higher incidence of corneal edema (eight percent in the intervention vs thirty percent in the control group), anterior chamber inflammation (seventeen percent vs seventy-four percent), additional laser capsulotomy (zero percent vs eighty-four percent) and increased visual axis opacification (four percent vs eighty-four percent).Conclusions:Minimally invasive capsulorhexis in children's cataracts seems to be a promising new procedure. Preliminary efficacy results were good and safety profile was better than standard treatment. However, it would be necessary to continue further studies to confirm these results.

Visual Axis Opacification after Congenital Cataract Surgery and Primary Intraocular Lens Implantation: Comparison of Three Different Lenses

Visual Axis Opacification after Congenital Cataract Surgery and Primary Intraocular Lens Implantation: Comparison of Three Different Lenses

Outcomes of cataract surgery in children with persistent hyperplastic primary vitreous.

To evaluate postoperative outcomes of cataract surgery in children with persistent hyperplastic primary vitreous (PHPV) and factors affecting outcomes. We analyzed 29 eyes of 28 children with PHPV presenting at a tertiary care center in northern India. All eyes underwent phacoaspiration followed by primary posterior capsulotomy with or without cauterization of persistent fetal vasculature under general anesthesia. Hydrophobic intraocular lens was implanted in selective cases. Postoperative outcomes such as clarity of visual axis, need for secondary surgical procedures, and complications were noted. Out of a total of 28 children (16 male and 12 female), 27 were unilateral while 1 patient had bilateral involvement. Mean age at surgery was 25.14 months, ranging from 2 months to 144 months. Mean axial length of the globe at surgery was 19.66 ± 2.28 mm. Cataract surgery with intraocular lens implantation was done in 22 eyes whereas 7 were left aphakic. The most common intraoperative complication noted was intraoperative bleed in 11 eyes (37.9%) resulting in postoperative hyphema in 9 eyes (31%) and vitreous hemorrhage in 8 eyes (27.5%). Visual axis opacification was seen in 12 eyes and all required membranectomy. Three eyes developed glaucoma while retinal detachment was noted in 2 eyes and 1 of them became phthisical. Favorable outcome was more often achieved in anterior PHPV. Surgical outcomes in eyes with PHPV undergoing cataract surgery are limited by intraoperative and postoperative complications such as hyphema, vitreous hemorrhage, recurrent visual axis opacification, glaucoma, and retinal detachment.

Twenty-five-gauge sutureless lensectomy in infants with congenital cataract

To evaluate the incidence of intra- and postoperative complications of transconjunctival 25-gauge (25G) sutureless pars plicata lensectomy. The medical records of patients <12 months of age with congenital cataracts who underwent 25G sutureless lensectomy were reviewed retrospectively. Patients were evaluated at postoperative days 1, 7, 15, 30, 60, and 90 and every 3 months thereafter. Visual acuity outcomes and intra- and postoperative complications were described and analyzed. A total of 72 eyes of 44 infants were included; 28 patients (64%) had bilateral cataract. Median follow-up was 28 months (range, 12-93 months). In 47 eyes (81%) there was improved visual acuity after surgery. Intraoperative adverse events occurred in 9 eyes (13%). Postoperative complications occurred in 14 eyes (19%): 6 eyes (8%) had secondary visual axis opacification, 6 eyes (8%) had secondary glaucoma, 1 eye (1%) had posterior synechiae, and 1 eye (1.4%) had retinal detachment. Transconjunctival pars plicata 25G sutureless lensectomy is a minimally invasive technique for congenital cataract treatment. No postoperative complications were observed in 81% of eyes. Visual acuity improved in 81% of the operated eyes.

Infantile cataract: comparison of two surgical approaches

ObjectiveTo compare the results of 2 cataract extraction techniques with primary intraocular lens (IOL) implantation in children. DesignRetrospective comparative case series study. MethodsThis study included children with congenital or developmental cataract. In all cases, anterior capsulorhexis, lens aspiration, posterior continuous curvilinear capsulorhexis, and primary IOL implantation were performed. We compared 2 surgical approaches. In the first approach, after IOL implantation in the bag, posterior optic capture (OC) was performed without anterior vitrectomy (OC technique); in the second approach, anterior vitrectomy was performed without OC of the IOL (AV technique). Patient demographic data as well as ethnic origin, child’s age at cataract diagnosis, child’s age at surgery, axial length, IOL power in diopters, visual acuity, visual axis opacification, and complications were assessed. ResultsOne hundred twenty-three eyes were included for surgical approach outcomes comparison; 21 eyes underwent the OC surgical approach and 102 the AV surgical approach. The mean patient age at surgery was 57.3 ± 47.1 months. The mean follow-up was 63.13 months (range 12–202 months). Epithelial lens reproliferation was the major adverse event in our series, affecting 21.1% of patients’ eyes; the mean time to epithelial lens reproliferation development was 90 ± 9.70 months. There was no statistically significant difference between the two groups in best spectacle-corrected visual acuity or epithelial lens reproliferation incidence. ConclusionsIn our case series we did not find any difference between surgical techniques.

Correlations of single nucleotide polymorphisms of CRYAA and CRYAB genes with the risk and clinicopathological features of children suffering from congenital cataract.

Background:The study aims to explore the correlations of the single nucleotide polymorphisms (SNPs) of CRYAA and CRYAB with the risk and clinicopathological features of children with congenital cataract.Methods:The study enrolled 168 children diagnosed as congenital cataract (case group) and 172 normal children (control group) from May 2015 to May 2016. Genomic DNA extraction was performed using a QIAamp DNA blood mini kit. Polymerase chain reaction (PCR) products were genotyped using an ABI direct sequencer. Haplotype, allele, and genotype frequencies of CRYAA and CRYAB gene polymorphisms analyses were carried out using the SHEsis software. Logistic regression analysis was performed in order to analyze the risk factors for children suffering from congenital cataract.Results:Presence of significant differences between the case and control groups’ genotype and allele frequencies of CRYAA rs7278468 and CRYAB rs370803064/rs387907338. TA of CRYAB gene might increase congenital cataract risk in children, while GCG of CRYAA gene and GC of CRYAB gene might decrease congenital cataract risk in children. CRYAA rs7278468, CRYAB rs370803064/rs387907338 polymorphisms were significantly correlated to uncorrected visual acuity, best-corrected visual acuity, nystagmus, visual axis opacification, microcornea, lens opacity, posterior capsular thickening, and degrees of posterior capsule opacification after operation in children with congenital cataract. Logistic regression analysis revealed that the T allele of CRYAA rs7278468, A allele of CRYAB rs370803064, T allele of CRYAB rs387907338, family history, and TA haplotype of CRYAB gene were risk factors for children with congenital cataract.Conclusion:Our findings demonstrated that CRYAA rs7278468 and CRYAB rs370803064/rs387907338 are correlated with the risk and clinicopathological features of children suffering from congenital cataract.

Long-term Outcomes of Primary Intraocular Lens Implantation in Patients Aged 7 to 24 Months

To report long-term outcomes of primary intraocular lens (IOL) placement in patients aged 7 to 24 months. This was a retrospective study of 27 consecutive patients (28 eyes) aged 7 to 24 months who underwent cataract surgery with primary IOL placement. Average follow-up was 62.7 ± 41.7 months and the mean age of surgery was 14.4 ± 5.6 months. Mean final visual acuity was 1.02 ± 0.72 logMAR (20/209). Adverse events occurred in 7 eyes (25%) and included visual axis opacification in 6 eyes and pupillary block glaucoma in 1 eye. Seven patients (25.9%) required additional intraocular surgery. Strabismus was present in 19 patients (70.4%). Better stereopsis was correlated with better final acuity. Cataract surgery with IOL placement in patients aged 7 to 24 months is associated with few complications. Visual axis opacification is the most frequent adverse event. [J Pediatr Ophthalmol Strabismus. 2017;54(3):149-155.].

Early versus late traumatic cataract surgery and intraocular lens implantation

PurposeTo determine the proper time for traumatic cataract surgery after open globe injuries.SettingFarabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.DesignRandomized clinical trial.Patients and methodsIn a randomized clinical trial, 30 eyes with traumatic cataract after open globe injury with IOL implantation underwent early (in the first week after the trauma) and 30 eyes underwent late cataract surgery (from the first to second month after the trauma). We excluded patients who were under 12-year-old. All patients were visited at 1 week, 4 weeks, 12 weeks, and 6 months after surgery. In each visit, patients were examined regarding visual acuity, intraocular pressure (IOP), anterior chamber inflammation, IOL position, and posterior synechiae. In addition, posterior segment evaluation and fundoscopy were performed. Intraoperative complication including posterior capsular rupture, anterior vitrectomy, and zonulysis as well as the site of IOL implantation were documented and post-operative complications including raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were listed.ResultsBest-corrected visual acuity 6 months after surgery was not different between the two groups. Also in early cataract surgery group, the rate of posterior capsular rupture was not significantly higher than the late surgery group (P=0.069). On the other hand, zonulysis was significantly higher in the late procedure group (P=0.039). Other complications including anterior vitrectomy, raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were not different in the two groups.ConclusionsEarly and late traumatic cataract surgery and IOL implantation after open globe injuries, have no significant difference regarding the post-surgical BCVA and prominent intraoperative and post-operative complications.

Outcome of various Hydrophobic Acrylic Intraocular Lens Implantations in Children with Congenital Cataract.

To evaluate performance of different intraocular lenses (IOLs) after cataract surgery in children aged less than 2 years with regards to rates of visual axis opacification (VAO). This was a retrospective chart review of children <2 years of age undergoing cataract surgery with primary posterior capsulotomy, anterior vitrectomy, and IOL over a period of 5 years with minimum follow-up of 1 year at a tertiary care institute. Children with microphthalmos, persistent fetal vasculature, traumatic cataract, aphakia, secondary IOLs, or any other coexisting ocular disease were excluded. A total of 257 eyes of 159 children were included in the study. The mean age at the time of surgery was 11.63 ± 7.916 months (range 6-23 months). A total of 29 eyes of 16 children underwent phacoaspiration with implantation of SA60 AT (AcrySof, Alcon, Fort Worth, TX); 75 eyes of 45 children received Hoya IOL (Hoya-PS AF-1 Series, Model PC-60AD, Hoya, Japan), 70 eyes of 46 patients received Sensar (Abbott Medical Optics Inc., Santa Ana, CA, USA), and 83 eyes of 52 children received MA60AC (AcrySof). At mean follow-up of 18.31 ± 15.04 months, 22.46% of the patients required resurgery for visual axis obscuration. By multiple regression analysis, the rate of visual axis obscuration was affected by the rate of perioperative complications (p = 0.001) and not affected by age (p = 0.98), type of IOL (p = 0.104), or site of IOL implantation (p = 0.603). Our findings suggest comparable rates of VAO for children less than 2 years of age receiving different types of hydrophobic acrylic IOLs.

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.

Globe Axial Length Growth at Age 5 Years in the Infant Aphakia Treatment Study

To report the longitudinal change in axial length (AL) from the time of unilateral cataract surgery at age 1 to 7 months to age 5 years, and to compare AL growth of operated eyes with that of fellow unoperated eyes. Comparative case series. Infants enrolled in the Infant Aphakia Treatment Study (IATS). The AL at baseline and age 5 years and change in AL were analyzed relative to treated versus fellow eye, visual outcome, and treatment modality (contact lens [CL] vs. intraocular lens [IOL]). Eyes with glaucoma or glaucoma suspect were excluded from primary analysis but reported separately. The AL growth from preoperative to age 5 years. Seventy patients were eligible; however, AL data for both eyes were available for 64 patients at baseline and 69 patients at age 5 years. The AL was significantly different between treated and fellow eyes preoperatively (18.1 vs. 18.7 mm, P < 0.0001) and at the final follow-up (21.4 vs. 22.1 mm, P= 0.0004). The difference in AL growth between treated and fellow eyes was not significant (3.3 vs. 3.5 mm, P= 0.31). The change in AL in eyes was similar with both treatments (CL 3.2 mm and IOL 3.4 mm, P= 0.53) and did not correlate with visual outcomes (P= 0.85). Eyes receiving additional surgery to clear the visual axis opacification grew significantly more compared with eyes not receiving surgery to clear the visual axis (3.8 vs. 2.7 mm, P= 0.013). Patients with glaucoma showed significantly more eye growth (5.7 mm) than those without glaucoma (3.3 mm) and glaucoma suspects (4.3 mm). Eyes treated for monocular cataract in infancy have axial growth similar to that of fellow eyes, despite having a shorter AL at the time of surgery. The change in AL in eyes was similar with both treatments (CL and IOL), did not correlate with visual outcomes, and was higher in eyes receiving additional surgery to clear the visual axis or eyes diagnosed with glaucoma.

Outcome of Cataract Surgery in Patients Treated for Retinopathy of Prematurity

Background/Aims: Pediatric patients with treated retinopathy of prematurity (ROP) may develop visually significant cataracts. We report the outcome of cataract surgery in patients who had ROP treatment. Method: Retrospective chart review of 19 eyes from 16 patients who had ROP treatment and subsequent cataract surgery between August, 2002 and March, 2015. Results: Eighteen of 19 eyes received laser treatment for ROP; 1 eye received intravitreal bevacizumab. 5 eyes received lens-sparing pars plana vitrectomy (LSPPV) in addition to laser. Average follow up was 10.1 ± 5.5 years. Average visual acuity improved from 20/324 prior to and 20/110 after cataract surgery (p = 0.06). 13/19 (68%) of the eyes received laser only and developed cataracts an average of 6.2 ± 5.6 years after laser treatment. 5/19 (26%) eyes developed cataracts an average of 6.4 ± 4.2 years after LSPPV and laser. In one eye, a cataract developed after a bevacizumab injection 2.9 years after the injection. Visual axis opacification (VAO) developed in 2/5 (40%) eyes after Ce/PCIOL/PPC-Antvx, 8/10 eyes (80%) after CE/IOL, and in 0/4 eyes after CE/PPC-AntVx. Ocular comorbidities included strabismus, nystagmus, amblyopia, optic atrophy, corneal band keratopathy, and phthisis bulbi. Conclusion: Cataract surgery in patients who have a history of ROP can be complicated by anatomical changes from prematurity and prior vitreoretinal surgeries. Vision improvement is limited by other ocular comorbidities.

Innovations in pediatric cataract surgery.

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

Cataract surgery in children with retinopathy of prematurity (ROP): surgical outcomes

PurposeTo report the outcomes of cataract surgery in children with retinopathy of prematurity (ROP).MethodsA retrospective case review of all children diagnosed with ROP from January 2001 to December 2014 was...