Pre- and Post-Operative Intraocular Pressure of Pediatric Cataract Surgery

Introduction: Cataract is an eye lens opacification which prevents clear vision. It is the leading cause of blindness and vision impairment worldwide, including Indonesia. It can also be occurred in children that leads to a major cause of childhood blindness. The prevalence of childhood cataract ranges from 3 to 6 per 10,000 children. The main treatment for cataract is surgery, although pediatric cataract surgery has several complications. One of the most severe complication is glaucoma due to increased intraocular pressure (IOP). This study aimed to determine pre- and post-operative IOP in pediatric cataract surgery.Methods: This was a cross-sectional observational analytic study. Secondary data were collected from medical records of Department of Ophthalmology, Dr. Soetomo General Hospital Surabaya from January 2017 to August 2019. Age, gender, pre- and post-operative IOP, and intraocular lens implantation data were taken. Calculation was performed using the Saphiro-Wilk for data less than 50 samples. The Saphiro-Wilk test results showed that the data were normally distributed (p = 0.628). Data processing were then performed using the parametric t-pair test with a confidence level ofResults: 32 eye samples were obtained from 16 pediatric cataract surgery patients. The mean of pre-operative IOP was 13.05 mmHg and the mean of post-operative IOP was 13.36 mmHg. There was an increase in post-operative IOP with an average increase of 0.31 mmHg. There was no significant difference between pre- and post-operative IOP of pediatric cataract surgery patients (p = 0.711).Conclusion: There was no difference between pre- and post-operative IOP of pediatric cataract surgery patients at Dr. Soetomo General Hospital Surabaya for the period of January 2017 - August 2019.

Review of Corticosteroid Use in Pediatric Cataract Surgery

Introduction: Following pediatric cataract surgery, an intense inflammatory response is related to various complications, including posterior capsule opacification (PCO), which is a visually threatening incidence that can lead to visual axis opacification (VAO). Although corticosteroids are essentially effective in reducing inflammation, potential ocular side effects are a remaining concern. Objective: This study aimed to review the efficacy and safety of corticosteroid drugs and their administration routes in pediatric patients who underwent cataract surgery Methods: A literature search was conducted from four electronic databases using keywords selected a priori. Identified articles were sorted according to the type of corticosteroid used, route of administration, and outcome measures, including inflammatory response and ocular side effects. Results: Five studies were included with one case series, one retrospective case-control, and three clinical trials. The total number of subjects was 311 patients, with an age range of six weeks to 15 years old. Four studies analyzed the use of triamcinolone acetonide intracamerally, which was superior to topical steroids. Most of the studies reported a decrease in inflammatory parameters. The outcome of PCO and VAO varied between studies. Nearly all the studies observed elevated intraocular pressure (IOP) as an ocular side effect. Conclusion: Various corticosteroids and different delivery routes can be used to ameliorate inflammation in pediatric cataract surgery. However, there is promising evidence suggesting intracameral steroids as substantially beneficial in reducing inflammatory parameters. Due to the limited number of studies reviewed, no firm conclusion regarding the superior steroid preparation or route of administration can be inferred. This review highlights the need for further studies.

Challenges of Pediatric Cataract Surgery in a Case of Seasonal Hyperacute Panuveitis (SHAPU)

A four-year-old female child diagnosed as a case of severe Seasonal Hyperacute Panuveitis (SHAPU) underwent lens-sparing core vitrectomy in her left eye with intravitreal antibiotic and steroid. Patient responded well to treatment and intraocular inflammation subsided. However, three months later, she developed vision impairing dense cataract which also made posterior segment assessment difficult. Lens aspiration with primary posterior capsulotomy and anterior vitrectomy with intraocular lens (IOL) implantation was performed. However, four weeks later, the patient developed occlusio pupillae with iris bombe. She did not respond to medical management so synechiolysis with surgical iridectomy was performed after which a normal depth anterior chamber was attained. Synechia and iris bombe were also relieved, and vision was regained.

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

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 < 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.