Visual Axis Opacification Research Articles

Visual axis reopacification after Nd:YAG laser posterior capsulotomy

Posterior capsular opacification (PCO) and anterior hyaloid face opacification are the two possible causes of visual axis opacification after cataract surgery, of which PCO is more common in adults. This is treated by neodymium-doped yttrium aluminum garnet (Nd:YAG) laser-assisted disruption of the opacified posterior capsule/membrane. Recurrence of visual axis opacification after a successful Nd:YAG laser posterior capsulotomy is infrequent. We report a case of visual axis reopacification after a successful Nd:YAG capsulotomy for PCO in an adult with no history of systemic or ocular disease who underwent phacoemulsification and an acrylic hydrophobic intraocular lens implantation. Patients should be explained about this possibility when undergoing Nd:YAG capsulotomy.

Complications, Visual Acuity, and Refractive Error 3 Years after Secondary Intraocular Lens Implantation for Pediatric Aphakia

To report the cumulative incidence of complications and describe refractive error and visual acuity (VA) outcomes in children undergoing secondary intraocular lens (IOL) implantation following previous surgery for non-traumatic cataract. Pediatric cataract registry. 80 children (108 eyes: 60 bilateral, 48 unilateral) undergoing lensectomy at <13 years of age, followed by secondary IOL implantation at median age (range) of 2.7 (0.6 to 5.0) years for bilateral and 2.1 (0.5 to 6.4) for unilateral cases. Annual data collection from medical record review through 5 years following lensectomy. Cumulative incidence of newly emergent complications following secondary IOL implantation; refractive error and VA by 5 years after lensectomy. Median (interquartile range [IQR]) follow-up following secondary IOL implantation was 2.5 years (0.8 to 3.3 years). A common complication following secondary IOL implantation was a glaucoma-related adverse event (GRAE: glaucoma or glaucoma suspect); the cumulative incidence was 17% (95% CI: 3%-29%) in bilateral and 12% (95% CI: 0%-23%) in unilateral cases. The cumulative incidence of surgery for visual axis opacification was 2% (95% CI: 0%-7%) for bilateral and 4% (95% CI: 0%-10%) for unilateral cases. Median prediction error (IQR) within 90 days of implantation was 0.88 D (-0.50 D to +3.00 D) less hyperopic than intended among 21 eyes for bilateral cases and 1.50 D (-0.25 D to +2.38 D) less among 19 unilateral cases. Median (IQR) spherical equivalent refractive error at 5 years (median 5.1 years of age) in eyes receiving a secondary IOL was +0.50 D (-2.38 D to +2.94 D) for 48 bilateral and +0.06 D (-2.25 D to +0.75 D) for 22 unilateral cases. Median (IQR) monocular VA at 5 years was 20/63 (20/50-20/100) for bilateral (n=42) and 20/400 (20/160-20/800) for unilateral (n=33) cases. Eyes with secondary IOL implantation have an ongoing risk of new glaucoma-related adverse events. Five years after lensectomy (approximately 2.5 years after secondary IOL implantation), average refractive error was less hyperopic than desired given the anticipated further myopic shift before refraction stabilizes.

Cataract surgery outcomes in children and adolescents with type 1 diabetes mellitus

PurposeTo report the outcomes of cataract surgery in children and adolescents with type 1diabetes mellitus. MethodsThe medical records of all pediatric patients (<18 years of age) with a diagnosis of type 1 diabetes mellitus who had undergone surgery for cataract between January 2000 and December 2019 at a tertiary care center were reviewed retrospectively. ResultsA total of 27 eyes of 15 patients who met the inclusion criteria were included. Median age at cataract surgery was 13 (IQR, 9.5-16) years, and median follow-up was 3.8 (IQR, 1.25-7.2) years, with 11 eyes followed for more than 5 years. Visual acuity improved from a median preoperative value of 0.8 (IQR, 0.55-1.3) logMAR to 0.15 (IQR, 0-0.45) logMAR at final follow-up. Posterior capsular visual axis opacification in 40.7% and diabetic retinopathy in 14.8% were the common complications requiring additional intervention, including laser capsulotomy and panretinal photocoagulation, respectively. ConclusionsCataract surgery in children and adolescents with type 1 diabetes leads to improvement in visual acuity. Proliferative diabetic retinopathy can lead to poor visual outcomes in these children. Visual axis opacification occurs at similar rates with or without primary posterior capsulorhexis.

Ten-year outcomes of congenital cataract surgery performed within the first six months of life.

To investigate the long-term outcomes of congenital cataract surgery performed within the first 6 months of life. 11 ophthalmic surgical sites in Japan. Retrospective chart review. Medical charts were retrospectively reviewed for 216 eyes of 121 patients. The age at surgery was 2.9 ± 1.7 months, with follow-up duration 13.0 ± 2.3 years. The cohort consisted of 83 cases with bilateral aphakia, 12 with bilateral pseudophakia, 20 with unilateral aphakia, and 6 with unilateral pseudophakia. Surgical intervention within the critical period of visual system development (10 weeks for bilateral and 6 weeks for unilateral cases) led to significantly better final visual acuity than surgery conducted after this time frame. The incidence of secondary glaucoma was similar between groups while the occurrence of visual axis opacification was more frequent with earlier surgery. A forward stepwise multiple regression analysis revealed that the final visual acuity was significantly associated with laterality of cataract (better outcomes in bilateral cases), phakic status (with pseudophakia outperforming aphakia), presence of systemic and ocular comorbidities, and development of secondary glaucoma. Secondary glaucoma was significantly more prevalent in aphakic eyes than pseudophakic eyes. In patients with genuine congenital cataract, surgery within the critical period of visual development results in better final visual acuity, albeit with an increased risk of visual axis opacification. The use of IOL with sophisticated surgical techniques shows promise even in congenital cataract surgery.

Factors affecting the visual outcome of paediatric cataract surgery: A hospital based prospective study in tertiary eye care

The aim of this study is to evaluate the various factors affecting the visual outcome of paediatric cataract surgery. Paediatric cataract is a huge problem of the world specially for developing and poor countries. Without treatment cataract can damage connection between brain and eye. So importance of early diagnosis and treatment can prevent permanent vision loss in children.Cataract in children can appear in variety of forms, each presenting in differencing in different way depending on the time. Sometime cataract associated with other ocular disease like coloboma, nystagmus, microphthalmos. These conditions are associated with poor prognosis. So proper visual rehabilitation of neuro- ophthalmic axis is crucial for good visual prognosis. All patients from 2 - 14 years of age who underwent cataract surgery in Department of Ophthalmology at BRLSABVMM College Rajnandgaon during 1- year period were included in the study. Detail history of patient, preoperative examination, ocular and systemic co-morbidity, intraoperative complications and post-operative outcome were documented and analysed. 25 patients underwent cataract surgery during this period.16 were male (64%) and 9 females (36%). Most common presenting symptom is diminution of vision in some cases nystagmus and strabismus also present. In some patient there is history of trauma also present. There was significant improvement in best corrected visual acuity following surgery in approx. 70% of patients. Visual axis opacification is most common complication after that fibrin reaction is other complication.: Improvement in vision in post operative paediatric cataract surgery due to early detection by parents and raise awareness by health workers of rural and urban area. Good visual outcome is depended on good infrastructure for operation theatre, advance microscope with instrument, advance cataract surgery with posterior capsulotomy and anterior vitrectomy, post-operative management and visual rehabilitation.

Visual axis opacification after pediatric cataract surgery - An analysis of morphology and etiology.

To investigate the morphological types and delineate the clinical and surgical variables associated with VAO in children undergoing pediatric cataract surgery. We included 33 eyes of 28 children who developed clinically significant visual axis opacification (VAO) after congenital or developmental cataract surgery. All eyes underwent a comprehensive examination under anesthesia followed by a membranectomy to clear the visual axis. We classified VAO into three subgroups: fibrotic, proliferative, and combined morphologies. We reviewed and analyzed the retrospective data and the findings during membranectomy to identify the etiological variables associated with various morphologies of VAO. The median age at primary surgery was 7 (2-96) months. The median interval from primary surgery to the first documentation of VAO was 6 (1-22) months. Younger children developed VAO sooner than older children. VAO was fibrotic in 11 eyes (33%), proliferative in 18 eyes (54.5%), and combined in four eyes (12.12%). Most children with fibrotic VAO belonged to economically disadvantaged sections of society ( P = 0.04). Lower age at primary surgery was the predominant risk factor for the development of VAO. Besides primary posterior capsulotomy and adequate anterior vitrectomy, a strict adherence to anti- inflammatory measures and follow up in necessary to prevent the occurrence of VAO. A close follow-up facilitates early detection and management, which can prevent the onset of visually impairing amblyopia.

The prevalence of visual axis opacification in the Swedish Pediatric Cataract Register.

To report on the occurrence of postoperative visual axis opacification (VAO) in children younger than 5 years of age operated for cataract in Sweden, and to analyse correlations with age at surgery and surgical method. Data were derived from the Swedish Pediatric Cataract Register (PECARE). All children operated on between 1 January 2007 and 31 December 2020 were included. Follow-ups at 1, 2 and 5 years of age were analysed. Cataract surgery were performed on 770 eyes belonging to 549 children (n = 282 boys, 51.4%); 327/770 (42.5%) of the children underwent surgery before 3 months of age and 216/770 (28%) before 6 weeks of age. Data on 881 follow-up visits were registered. At the follow up-visits at 1, 2 and 5 years of age, VAO was present in 154/349 (44.1%), 41/323 (12.7%) and 25/208 (12%). The majority of the children with VAO underwent cataract surgery before age 6 months, with a predominance before age 2 months. Primary IOL was implanted in 601/770 (78%) of eyes; 40.8% had an acrylic one-piece lens, 31.8% had a bag-in-the-lens IOL, 21.9% were aphakic and 5.2% had an acrylic three-piece lens. Implantation of a bag-in-the-lens IOL was related to a significantly lower occurrence of VAO compared to other types of IOL, including aphakia (p < 0.0002). Our results are in accordance with the literature. Primary bag-in-the-lens IOL implantation before 2 years of age seems adequate and safe, with a low occurrence of VAO, and can thus be continued as routine in Sweden.

10-Year Outcomes of Pediatric Cataract Surgery with Foldable Intraocular Lens Implantation and Posterior Continuous Curvilinear Capsulorhexis.

We investigated the long-term outcomes of pediatric cataract surgeries performed with modern surgical techniques involving in-the-bag implantation of a foldable intraocular lens (IOL). Data were retrospectively collected from 42 eyes in 30 patients who underwent surgery at 6 years and younger (average 2.5 ± 2.3 years) and were followed up for an average of 12.2 ± 2.4 years (10-17 years). Surgical procedures included anterior continuous curvilinear capsulorhexis (CCC), lens removal, posterior CCC, anterior vitrectomy, and in-the-bag IOL implantation. There were 18 unilateral (2.7 ± 2.3 years) and 12 bilateral cases (2.3 ± 2.3 years), with no significant age difference between groups (p = 0.462). The mean best-corrected visual acuity (BCVA) at the final visit was 0.453 ± 0.488 (logMAR), correlating significantly with the age at surgery (r = -0.307, p = 0.048). The unilateral group had a worse BCVA (0.658 ± 0.615) than the bilateral group (0.298 ± 0.294) (p < 0.001). On average, eyes showed a myopic shift of -6.0 ± 6.3D, which significantly correlated with surgical age (r = 0.402, p = 0.008). While the myopic shift was -8.2 ± 6.1 D in the unilateral group and -4.9 ± 6.4 D in the bilateral group, the net shift for unilateral cases (comparing pseudophakic and fellow eyes) was -4.8 D. Three eyes (7.1%) exhibited suspected glaucoma (increased intraocular pressure), but no glaucoma or other severe complications were noted. IOL exchange surgery was necessary in two eyes (4.8%) due to pronounced myopic drift and significant IOL decentration. Three eyes (7.1%) required surgery for significant visual axis opacification. Contemporary surgical strategies appear to yield promising long-term outcomes in patients with infantile cataracts.

Hydrophilic Versus Hydrophobic Acrylic Intraocular Lens Implantation in Paediatric Cataract Surgery

Introduction: The selection of intraocular lens is still debatable in paediatric eye. Due to low cost and fewer intra-operative complication hydrophilic acrylic intraocular lens are implanted in volume in low income countries. There is lack of comparative study of this type of lens with hydrophobic lens in paediatric population.&#x0D; Aims: To compare the outcomes of hydrophilic acrylic lens and hydrophobic acrylic lens in paediatric cataract surgery.&#x0D; Methods: Out of 48 eyes included in the study, the Group A (n =24) eyes were implanted with acrylic hydrophilic intraocular lens, and the Group B (n =24) were implanted with acrylic hydrophobic intraocular lens. The children were evaluated pre, intra and postoperatively for different parameter.&#x0D; Results: The mean age was 6.6±2.7 years at the time of surgery. The most common type of cataract was zonular (58% in Group A and 50% in Group B). Postoperatively, corneal edema was seen in 7(29%) eyes in group A and in 2(8%) eyes in group B. The mean follow-up was 16.9±2.9 months. At one year, the position of the intraocular lens was in the capsular bag in 20 eyes (88.33%) and 24 eyes (100 %) in the group A and B, respectively. Clear visual axis was present in 22 eyes in Group A and 24 eyes in Group B. Posterior capsule opacification occurred in 12(50%) eyes in Group A and 6(25%) eyes in Group B. Two (8.3%) eyes in group A underwent surgical membranectomy due to visual axis opacification. The mean LogMAR visual acuity was 0.56 and 0.52 in group A and B respectively at one year.&#x0D; Conclusion: Hydrophilic acrylic intraocular lens are good alternative to hydrophobic intraocular lens in Nepal in the treatment of paediatric cataract.

Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract

Lensectomy with primary intraocular lens (IOL) implantation is often used in the management of nontraumatic pediatric cataract, but long-term data evaluating the association of age and IOL location with the incidence of complications are limited. To describe the incidence of complications and additional eye surgeries through 5 years following pediatric lensectomy with primary IOL implantation and association with age at surgery and IOL location. This prospective cohort study used Pediatric Eye Disease Investigator Group cataract registry data from 61 institution- and community-based practices over 3 years (June 2012 to July 2015). Participants were children younger than 13 years without baseline glaucoma who had primary IOL implantation (345 bilateral and 264 unilateral) for nontraumatic cataract. Data analysis was performed between September 2021 and January 2023. Lensectomy with primary IOL implantation. Five-year cumulative incidence of complications by age at surgery (<2 years, 2 to <4 years, 4 to <7 years, and 7 to <13 years) and by IOL location (sulcus vs capsular bag) were estimated using Cox proportional hazards models. The cohort included 609 eyes from 491 children (mean [SD] age, 5.6 [3.3] years; 261 [53%] male and 230 [47%] female). Following cataract extraction with primary IOL implantation, a frequent complication was surgery for visual axis opacification (VAO) (cumulative incidence, 32%; 95% CI, 27%-36%). Cumulative incidence was lower with anterior vitrectomy at the time of IOL placement (12%; 95% CI, 8%-16%) vs without (58%; 95% CI, 50%-65%), and the risk of undergoing surgery for VAO was associated with not performing anterior vitrectomy (hazard ratio [HR], 6.19; 95% CI, 3.70-10.34; P < .001). After adjusting for anterior vitrectomy at lens surgery, there were no differences in incidence of surgery for VAO by age at surgery (<2 years, HR, 1.35 [95% CI, 0.63-2.87], 2 to <4 years, HR, 0.86 [95% CI, 0.44-1.68], 4 to <7 years, HR, 1.06 [95% CI, 0.72-1.56]; P = .74) or by capsular bag vs sulcus IOL fixation (HR, 1.22; 95% CI, 0.36-4.17; P = .75). Cumulative incidence of glaucoma plus glaucoma suspect by 5 years was 7% (95% CI, 4%-9%), which did not differ by age after controlling for IOL location and laterality. In this cohort study, a frequent complication following pediatric lensectomy with primary IOL was surgery for VAO, which was associated with primary anterior vitrectomy not being performed but was not associated with age at surgery or IOL location. The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring.

Risk of visual axis opacification in infants with and without primary IOL implantation after congenital cataract surgery performed during the first 4 months of age

PurposeThe study evaluates the rate of postoperative formation of a pupillary membrane (PM) and posterior visual axis opacification (PVAO) in infants with and without primary IOL implantation during the first 4 months of infancy.MethodsMedical records for 144 eyes (101 infants) operated between 2005 and 2014 were evaluated. A posterior capsulectomy and anterior vitrectomy were performed. Primary IOL implantation was performed in 68 eyes, while 76 eyes were left aphakic. There were 16 bilateral cases in the pseudophakic group and 27 in the aphakic group. The follow-up period was 54.3 ± 21.05 months and 49.1 ± 18.60 months, respectively. Fisher’s exact test was used for statistical analysis. The two-sample t-test with equal variance was used to compare surgery age, follow-up period and time intervals of complications.ResultsThe mean age of surgery was 2.1 ± 0.85 months in the pseudophakic and 2.2 ± 1.01 months in the aphakic group. PM was diagnosed in 40% pseudophakic and 7% aphakic eyes. A second surgery for PVAO was performed in 72% pseudophakic and 16% aphakic eyes. Both were significantly higher in the pseudophakic group. In the pseudophakic group, the number of PVAO was significantly higher in infants operated before 8 weeks of age compared to surgery age 9–16 weeks. The frequency of PM was not age-dependent.ConclusionAlthough it remains feasible to implant an IOL during the primary surgery, even in very young infants, there should always be solid arguments for this decision since it puts the child at higher risk of repeated surgeries under general anaesthesia.

Treatment of visual axis opacification and secondary membranes with Nd:YAG laser after pediatric cataract surgery under intranasal sedation.

To describe neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser treatment of visual axis opacification and secondary membranes in pediatric patients with cataracts under intranasal dexmedetomidine sedation. Twenty eyes of 17 patients with secondary membrane formation after cataract extraction were enrolled in this study. Intranasal dexmedetomidine sedation (3 ug/kg) was administered, and Nd:YAG laser (Ellex Super Q, Adelaide, Australia) procedures were performed with children in the sitting position with their chin supported on a laser delivery slit lamp. Preoperative and postoperative visual acuities were documented, and medical records were reviewed. The age of the patients ranged from 5 to 83 months (31.82 ± 27.73). Nineteen (95.0%) eyes had congenital cataracts and one (5.0%) had a traumatic cataract. Nd:YAG laser treatment of VAO with ten (50.0%) eyes, pupillary membranes with three (15.0%) eyes, pupillary cortical proliferation with six (30.0%) eyes, and anterior capsule contraction with one (5.0%) eye. Five (25.0%) eyes demonstrated visual acuity improvement, whereas six (30.0%) eyes remained unchanged after laser treatment. The recurrence rate was 30.0% and four eyes underwent a second Nd:YAG membranectomy. No side effects or tolerances due to sedative drugs were observed. Nd:YAG laser membranectomy under intranasal dexmedetomidine sedation was safely performed in children as young as 5 months old in a sitting position. This approach facilitates patient convenience, doctor proficiency, and cost reductions. Patients with recurrence can be treated by repeating the procedure.

Posterior Capsulotomy Size Affects the Formation of Significant Visual Axis Opacification in Congenital and Developmental Cataract.

To assess the relationship between posterior capsulotomy size and significant visual axis opacification (VAO) in congenital and developmental cataract. The charts of children aged 7 years and younger who underwent cataract surgery including primary posterior capsulotomy (PPC) and limited anterior vitrectomy between 2012 and 2022 were retrospectively reviewed. Eyes with PPC size smaller than the anterior capsulotomy size were considered as group 1. Eyes with PPC size larger than the anterior capsulotomy size were considered as group 2. Clinical characteristics, the need for Nd:YAG laser treatment or further surgery for significant VAO, and other postoperative complications were compared between the groups. Sixty eyes of 41 children were included in the study. The median age at the time of surgery was 5.5 and 3 years in groups 1 and 2, respectively (P = .076). Primary intraocular lens implantation was performed in 23 (85.2%) eyes in group 1 and 25 (75.8%) eyes in group 2 (P = .364). There was no difference between the groups in terms of postoperative visual acuity (P = .983) and refractive errors (P = .154). Eight (29.6%) pseudophakic eyes received Nd:YAG laser treatment in group 1, but none of the eyes in group 2 (P = .001). Four (14.8%) eyes in group 1 and 1 (3%) eye in group 2 underwent further surgery for VAO (P = .100). The need for further intervention for significant VAO was statistically higher in group 1 (44.4% vs 3%, P < .001). Larger PPC size in pediatric cataract may reduce the need for further intervention for significant VAO. [J Pediatr Ophthalmol Strabismus. 2023;60(6):441-447.].

Bag-in-the-lens intraocular lens implantation before 12 weeks of age in congenital cataract.

The aim of this study was to evaluate the intra- and postoperative complications, especially the risk of visual axis opacification (VAO), following the implantation of the bag-in-the-lens (BIL) intraocular lens (IOL) in infants with congenital cataract operated on before 12 weeks of age. Infants operated on before 12 weeks of age between June 2020 and June 2021 with a follow-up longer than 1year were included in the present retrospective study. This was a first-experience cohort of an experienced paediatric cataract surgeon with this type of lens. Nine infants (13 eyes) with a median age at surgery of 28 days (range, 21-49 days) were included. The median follow-up time was 21.6months (range, 12.2-23.4months). The lens was correctly implanted with the anterior and posterior capsulorhexis edges placed into the interhaptic groove of the BIL IOL in seven of 13 eyes; none of these eyes developed VAO. In the remaining six eyes, the IOL was only fixated to the anterior capsulorhexis edge, and in these cases, an anatomical anomaly of the posterior capsule and/or anterior vitreolenticular interface dysgenesis were observed. These six eyes developed VAO. One eye had a partial iris capture in the early postoperative phase. Otherwise, the IOL remained well centred and stable in all eyes. Anterior vitrectomy was necessary in seven eyes due to vitreous prolapse. One patient with unilateral cataract was diagnosed with bilateral primary congenital glaucoma at 4months of age. Implantation of the BIL IOL is safe even in the youngest age group less than 12 weeks of age. Although being a first-experience cohort, the BIL technique is shown to reduce the risk of VAO and the number of surgical procedures.

Outcomes of surgical treatment of congenital cataract with microphthalmia in infancy

Objective: To examine the outcomes of surgical treatment for infants with congenital cataract and microphthalmia (CATM). Methods: It was a retrospective case series study. Data of 28 (55 eyes) CATM children who underwent cataract surgery at the Qingdao Eye Hospital of Shandong First Medical University and were followed up for more than 5 years between January 2010 and December 2014 under the age of 6 months. There were 15 male and 13 female children. The age at the time of surgery was (3.2±1.3) months, and the follow-up time was (8.2±1.7) years. The data included the basic information of the children, the ocular biological parameters before and after surgery and intraocular lens (IOL) implantation, and the occurrence of complications. Paired t-tests or Wilcoxon signed rank tests were used to compare groups, and logistic regression analysis was used to identify factors related to IOL implantation, secondary glaucoma, and visual axis opacification (VAO). Results: The mean preoperative axial length was (16.6±1.0) mm, and the mean horizontal corneal diameter was (9.5±0.9) mm. The axial growth rate within 2 years after the first stage of surgery was (1.4±0.8) mm/year. None of the children had an IOL implanted before the age of 2. Sixty percent of the eyes (33/55) received IOL implantation within 2 to 4 years after the first stage of surgery, while the remaining 40% (22/55) did not receive IOL implantation at the last follow-up. The axial growth rate was (0.9±0.7) mm/year within two years after the second stage of surgery. Postoperative secondary glaucoma occurred in 7 eyes (12.7%), and VAO occurred in 15 eyes (27.3%). IOL implantation was associated with preoperative axial length (OR=0.072, P<0.001) and age at the first stage of surgery (OR=7.270, P<0.001), but not with preoperative corneal diameter (P=0.735). The incidence of VAO was associated with preoperative corneal diameter (OR=4.124, P=0.011), but not with age at the first stage of surgery (P=0.489) or preoperative axial length (P=0.489). No factors related to the occurrence of secondary glaucoma were found. The best corrected visual acuity at the last follow-up after IOL implantation was (0.37±0.28) logMAR, which was better than that of children without IOL implantation (0.67±0.19) logMAR (U=49.50, P=0.003). Conclusions: Children with CATM can obtain the opportunity for IOL implantation through early surgery and ultimately achieve good visual outcomes. Properly selecting the timing for implanting IOL can keep the incidence of secondary glaucoma at an acceptable level.

Visual outcomes and safety profile of intraocular lens implantation versus aphakia in children with microspherophakia with no subluxation

ObjectiveTo study the visual, refractive and surgical outcomes of intraocular lens (IOL) implantation versus aphakia in children with microspherophakia.DesignRetrospective, comparative, non-randomised interventional study.MethodsAll consecutive children with microspherophakia who satisfied the...

Optic Capture Without Anterior Vitrectomy in Pediatric Cataract Surgery

To compare outcomes of 2 surgical techniques in children undergoing cataract surgery with intraocular lens (IOL) implantation: optic capture of IOL without anterior vitrectomy (AV) or in-the-bag IOL with AV. Prospective randomized controlled trial. Patients were randomized to 2 groups: optic capture without AV (group 1) or in-the-bag implantation with AV (group 2). The following variables were compared: visual axis opacification (VAO), inflammatory deposits on IOL surface, anteroposterior synechia, IOL tilt and decentration, lenticular astigmatism, refractive prediction error, and posterior segment complications. Fifty-one eyes of 37 children were investigated with a mean follow-up of 20.1±8.5 months. Group 1 and group 2 had mean ages of 59.2±32.6 and 46.5±21.9 months, respectively (P=.104). Three eyes in group 1 and 2 eyes in group 2 developed VAO (P=.656). Two eyes in group 1 and 5 eyes in group 2 developed anteroposterior synechia (P=.291). Six eyes in group 1 and 11 eyes in group 2 had inflammatory deposits on the IOL (P=.233). Both groups had similar IOL tilt and decentralization (for all meridians, P > .05). The absolute refractive prediction error was 0.55±0.34 diopter (D) and 0.53±0.3 D, respectively (P=.294). Each group had 1 eye with intraocular hypertension (P=.932). The optic capture method was similar to the conventional technique in the quantitative evaluation of comprehensive data such as visual axis opacification, inflammatory sequelae, refractive outcomes, and IOL stability. The optic capture technique is an appealing option for pediatric cataract surgery because it eliminates the requirement for vitrectomy.

Clinical case of visual axis opacification after primary posterior capsulorhexis

The formation of posterior continuous capsulorhexis during cataract removal has traditionally been used to prevent visual axis opacification. According to the current literature, closure of the posterior capsulorhexis opening in our patient's case should not have developed in a period of 1year, but it did in only one of the two eyes, despite the presence of equal conditions the same surgeon, the same IOL (sharp-edged hydrophilic acrylic with hydrophobic coating), no concomitant eye diseases and somatic pathology. We conducted a literature search to find the cause of the unilateral development of this complication, as well as the optimal treatment method. The difference between two surgeries was in the diameter of the anterior and posterior capsulorhexis on the right eye they were 0.51.0mm larger than on the left eye, and the left eye has developed opacity, which required surgery. An effective and safe way of treating this problem is the capsulotomy using a 25gauge-vitreotome. The clinical case shows the need for further research on this topic, as formation of posterior continuous capsulorhexis has a risk of intra- and postoperative complications, and more data should be considered to ensure that there is no such recurrence of opacity.

Surgical interventions for bilateral congenital cataract in children aged two years and under.

Surgical interventions for bilateral congenital cataract in children aged two years and under.

Management of cataract surgery in Lowe syndrome.

To evaluate the ophthalmic and anesthesiologic management of cataract surgery in children with Lowe syndrome receiving lens removal, the development and management of secondary glaucoma. This retrospective case series included 12 eyes of 6 children with genetically verified Lowe syndrome receiving cataract removal. Information regarding the type and duration of surgery and total anesthesia time were recorded. Additionally, intra- and postoperative complications were noted as well as clinical examinations such as visual acuity and funduscopy. All children received simultaneous bilateral cataract surgery at the mean age of 8.98±3.58wk. Lensectomy combined with posterior capsulotomy and anterior vitrectomy was performed in all children. The mean time for cataract surgery per eye was 35.83±8.86min, whereas the total time of surgery was 153.33±22.11min. The mean extubation time and duration at recovery room was 42.33±22.60min and 130.00±64.37min, respectively. During surgery, a decrease of oxygen saturation below 93% was found in only one child. During the postoperative follow-up, nystagmus (6 children) and strabismus (5 children) was commonly found in contrast to no case of visual axis opacification. Secondary glaucoma developed in five eyes of three children, which was treated with topical eye drops in only one child. A trabeculectomy was performed in both eyes of one child, whereas removal of syechia and an iridectomy in one eye of one child. Bilateral simultaneous cataract surgery under general anesthesia is a safe surgical procedure in Lowe syndrome children. The glaucoma screening with intraocular pressure measurements is crucial in the postoperative management of Lowe syndrome patients to avoid additional visual impairment.