scholarly journals Visual Axis Opacification in Children Following Paediatric Cataract Surgery

2014 ◽  
Vol 52 (196) ◽  
pp. 1024-1030 ◽  
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.

Management Options in Pediatric Cataract

2012 ◽  
Vol 05 (01) ◽  
pp. 44
Author(s):  
Abhay R Vasavada ◽  
Sajani K Shah ◽  
Vaishali Vasavada ◽  
◽  
◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Visual Development ◽  
Successful Outcome ◽  
Visual Axis ◽  
Management Options ◽  
Pediatric Cataract ◽  
Visual Rehabilitation ◽  
Term Care ◽  
Pediatric Cataract Surgery ◽  
Axial Growth

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.

scholarly journals Outcome of Pediatric Cataract Surgeries in a Tertiary Center in Switzerland

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Sarah Claudia Ambroz ◽  
Marc Töteberg-Harms ◽  
James V. M. Hanson ◽  
Jens Funk ◽  
Daniel Barthelmes ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Anterior Segment ◽  
Retrospective Chart Review ◽  
Visual Outcome ◽  
Posterior Capsular Opacification ◽  
Pediatric Cataract ◽  
Tertiary Center ◽  
Significant Difference ◽  
Aphakic Glaucoma ◽  
Pediatric Cataract Surgery

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.

scholarly journals Comparison Between Nylon and Polyglactin Sutures in Pediatric Cataract Surgery: A Randomized Controlled Clinical Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Mathias V. Melega ◽  
Roberto dos Reis ◽  
Rodrigo Pessoa Cavalcanti Lira ◽  
Denise Fornazari de Oliveira ◽  
Carlos Eduardo Leite Arieta ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cataract Surgery ◽  
Pediatric Patients ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Pediatric Cataract ◽  
Clinical Trial Registration ◽  
Surgical Incisions ◽  
Pediatric Cataract Surgery ◽  
Group B

Purpose: To compare the performance of nylon sutures to that of polyglactin sutures in pediatric patients undergoing cataract surgery.Setting: University of Campinas (UNICAMP), Campinas, São Paulo, BrazilDesign: A prospective, randomized, partially masked, single-site clinical trial. (https://clinicaltrials.gov/ct2/show/NCT03812640).Methods: A total of 80 eyes from 80 patients who underwent pediatric cataract surgery were randomized into two groups in block sizes of four. Group A consisted of 41 patients whose surgical incisions were sutured with polyglactin 10-0 material. Group B consisted of 39 patients whose surgical incisions were sutured with nylon 10-0 material. The primary outcome was frequency of suture-related complications in each group. Secondary outcomes were the frequency with which suture removal was necessary.Results: The incidence of suture-related complications within 6 months of follow up was 0 out of 41 eyes (0.00%) in the polyglactin group and 17 out of 39 eyes (43.59%) in the nylon control group (p &lt; 0.001). In all of the eyes with suture-related complications, the sutures were promptly removed. The most frequent complications were vascularization near the suture (17.95%) and loose sutures (17.95%). No ocular or systemic study-related adverse events were observed.Conclusions: Polyglactin sutures were found to be safe and effective for pediatric patients undergoing cataract surgery. Their lower rate of complications and reduced likelihood of removal (and the subsequent need for general anesthesia) make their use preferrable to that of nylon sutures. This study represents the first controlled randomized clinical trial to compare nylon sutures to polyglactin sutures in pediatric patients undergoing cataract surgery.Clinical Trial Registration: URL: https://clinicaltrials.gov/ct2/show/, Identifier: NCT03812640.

scholarly journals Angle Surgery in Pediatric Glaucoma Following Cataract Surgery

Vision ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 9
Author(s):  
Emery C. Jamerson ◽  
Omar Solyman ◽  
Magdi S. Yacoub ◽  
Mokhtar Mohamed Ibrahim Abushanab ◽  
Abdelrahman M. Elhusseiny
Keyword(s):  
Cataract Surgery ◽  
Surgical Techniques ◽  
First Line ◽  
Pediatric Cataract ◽  
Surgical Interventions ◽  
Pediatric Glaucoma ◽  
Initial Procedure ◽  
Pediatric Cataract Surgery ◽  
Study Designs

Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of surgery, microcornea, and additional surgical interventions. The exact mechanism for GFCS has yet to be completely elucidated. While medical therapy is the first line for treatment of GFCS, many eyes require surgical intervention, with various surgical modalities each posing a unique host of risks and benefits. Angle surgical techniques include goniotomy and trabeculotomy, with trabeculotomy demonstrating increased success over goniotomy as an initial procedure in pediatric eyes with GFCS given the success demonstrated throughout the literature in reducing IOP and number of IOP-lowering medications required post-operatively. The advent of microcatheter facilitated circumferential trabeculotomies lead to increased success compared to traditional <180° rigid probe trabeculotomy in GFCS. The advent of two-site rigid-probe trabeculotomy indicated that similar results could be attained without the use of the more expensive microcatheter system. Further studies of larger scale, with increased follow-up, and utilizing randomization would be beneficial in determining optimum surgical management of pediatric GFCS.

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

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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