Posterior capsulorhexis with optic capture: Maintaining a clear visual axis after pediatric cataract surgery

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.

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Visual Axis Opacification in Children Following Paediatric Cataract Surgery

Journal of Nepal Medical Association ◽

10.31729/jnma.2807 ◽

2014 ◽

Vol 52 (196) ◽

pp. 1024-1030 ◽

Cited By ~ 4

Author(s):

Ujjowala Devi Shrestha ◽

Mohan Krishna Shrestha

Keyword(s):

Cataract Surgery ◽

Pediatric Patients ◽

Influencing Factor ◽

Surgical Techniques ◽

Visual Development ◽

Posterior Capsular Opacification ◽

Visual Axis ◽

Pediatric Cataract ◽

Pediatric Cataract Surgery ◽

Equipment Type

Visual axis opacification (VAO) occurs in up to 40% of pediatric patients after cataract surgery withintraocular lens implantation(IOL) even with a primary posterior capsulotomy (PPC). In both children and adult group, opacification does obscure the visual axis. However, in children after PPC, there is no capsule. Hence, the terminology VAO is used in children rather than posterior capsular opacification. This opacification is caused by a proliferation of epithelial cells on the posterior capsule or anterior vitreous face and can hinder the optical image quality needed for normal visual development. The rate of epithelial mitotic activity is higher in children compared to adult. It can be managed by Yag laser or surgical membranectomy, the latter is preferable. International and national published articles were systematically reviewed on aetio-pathogenesis, surgical techniques and equipment, type and material of IOL, and management of VAO in children operated for cataract. Author's experience was also included to write manuscript. VAO is frequent complication following cataract surgery in pediatric patients. Age of cataract patients, surgical technique and type and materials of IOL are most common influencing factor for VAO. Immediate management with advance equipment of VAO reduces the incidence for development of irreversible stimulation deprivation amblyopia. Keywords: pediatric cataract; pediatric cataract surgery; visual axis opacification.

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Pediatric Cataract Surgery

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/s-2004-820202 ◽

2004 ◽

Vol 221 (S 1) ◽

Author(s):

AR Vasavada

Keyword(s):

Cataract Surgery ◽

Pediatric Cataract ◽

Pediatric Cataract Surgery

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Clinical characteristics and treatment of secondary glaucoma, glaucoma suspects and ocular hypertension after congenital cataract surgery

European Journal of Ophthalmology ◽

10.1177/1120672121991356 ◽

2021 ◽

pp. 112067212199135

Author(s):

Katharina Eibenberger ◽

Barbara Kiss ◽

Ursula Schmidt-Erfurth ◽

Eva Stifter

Keyword(s):

Intraocular Pressure ◽

Cataract Surgery ◽

Ocular Hypertension ◽

Congenital Cataract ◽

Case Series ◽

Secondary Glaucoma ◽

Visual Axis ◽

Retrospective Case ◽

Pediatric Cataract ◽

Congenital Cataract Surgery

Objective: To evaluate changes in intraocular pressure after congenital cataract surgery in a real-world setting. Methods: This retrospective case series included all children aged 0–2 years undergoing lens extraction due to congenital cataract. Development of an elevated intraocular pressure was divided into three groups: secG, suspG and OHT. Further, risk factors for IOP changes, the therapeutic approach and functional outcome were assessed during follow-up. Results: One hundred and sixty-one eyes of 110 patients aged 0–2 years were included, whereof 29 eyes of 17 children developed secondary glaucoma (secG; 11 eyes/8 patients), glaucoma suspect (suspG; three eyes/three patients) or ocular hypertension (OHT; 15 eyes/10 patients). No difference in surgrical procedure ( p = 0.62) was found, but age at cataract surgery differed significantly ( p = 0.048), with the secG group (1.74 ± 1.01 months) being the youngest (suspG: 3.93 ± 1.80 months; OHT group: 5.91 ± 5.36 months). Secondary surgical intervention was significantly higher in the secG (4.64 ± 3.41) followed by the suspG (2.00 ± 2.65) and OHT groups (0.40 ± 0.74; p < 0.001). Postoperative complications including nystagmus ( p = 0.81), strabismus ( p = 0.98) and amblyopia ( p = 0.73) showed no difference, in contrast to visual axis obscuration which was more common in the secG group ( p = 0.036). Conclusion: Initial lensectomy and anterior vitrectomy procedure together with or without IOL implantation seems to have no influence for the development of IOP changes after pediatric cataract surgery. However, children who developed secondary glaucoma had cataract surgery significantly earlier, within the first 2–3 months of life. Glaucoma surgery was required to achieve final IOP control in most eyes. The development of secondary glaucoma was also associated with a significant increase in surgical re-treatments.

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