Visual outcomes in pediatric traumatic cataract

To study epidemiology, biometry and visual outcomes (with or without posterior capsulorhexis) in cases of pediatric traumatic cataract. This was a prospective observational study conducted on 30 children of traumatic cataract belonging to an age group of less than 16 years. All patients were subjected to detailed history and ocular examination. Patients underwent cataract surgery with or without intraocular lens (IOL) implantation. Posterior capsulorhexis with posterior optic capture was done in all patients presenting with primary posterior capsular opacity. All patients were followed up till 6 months and surgical outcomes in terms of Best Corrected Visual Acuity (BCVA), and visual axis opacification (VAO) were observed. Firecracker injury was found to be the most common causal agent, followed by arrow and ball injuries. Males were more commonly injured than females (70%:30%). Open-globe injury was more frequent than closed globe injury (CGI) (53.3%:46.7%). Anterior capsular rupture was the most frequent preoperative complication. Mean axial length was 22.53 which was not significantly different from the fellow eye. 3 patients were left aphakic, 10 patients underwent single piece IOL implantation and 16 patients underwent multipiece IOL implantation. Anterior chamber IOL (ACIOL) was implanted in one case. Intraoperatively 6 patients were found to have posterior capsular plaque and were implanted with multipiece IOL with posterior optic capture. Visual acuity significantly improved in 21 out of 30 eyes from baseline after cataract surgery (p<0.001). 9 patients (30%) had posterior capsular opacification (PCO) on follow up. Posterior capsular opacity in pediatric traumatic cataracts can be effectively managed with posterior capsulorhexis and posterior optic capture.

Corneal Endothelial Changes Following Early Capsulotomy Using Neodymium:Yttrium-Aluminum-Garnet Laser

We aimed to survey whether the timing of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy would alter the corneal endothelial morphology and density. A retrospective cohort study was conducted, and 48 patients with unilateral posterior capsular opacity (PCO) and Nd:YAG laser capsulotomy performance were enrolled. The participants were divided into the early Nd:YAG group (timing ≤ 12 months, n = 20) and late Nd:YAG group (timing > 12 months, n= 28) depending on elapsed months between phacoemulsification and Nd:YAG laser capsulotomy. Endothelial cell density (ECD), coefficient of variant (CV), hexagonality (HEX), and central corneal thickness (CCT) between the two groups were collected. A generalized estimate equation was conducted to evaluate the corneal endothelial parameters between the two groups with an adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA was improved after treatment in both groups (both p < 0.001). Chronically, ECD in the early group was significantly decreased one week after treatment (2221.50 ± 327.73/mm2 vs. 2441.55 ± 321.80/mm2, p < 0.001), which recovered to 2369.95 ± 76.37/mm2 four weeks after the treatment but was still lower than the preoperative status (p < 0.001). In addition, the HEX percentage showed a significant reduction at four weeks after treatment (p = 0.028). The ECD in the early group was significantly lower than that in the late group (aOR: 0.167, 95% CI: 0.079–0.356, p = 0.003) in both week 1 (p < 0.001) and week 4 (p = 0.004) after laser treatment. In conclusion, the early application of Nd:YAG laser capsulotomy within one year after cataract surgery may be the reason for postoperative ECD decrement without known etiology.

Efficacy and safety of primary posterior capsulotomy during phaco-vitrectomy for epiretinal membrane

Purpose To evaluate the necessity and safety of primary posterior capsulotomy during phaco-vitrectomy for idiopathic epiretinal membrane (ERM). Setting Seoul National University Bundang Hospital, Seongnam, Korea. Design Retrospective consecutive cohort analysis. Methods This study enrolled 219 patients (228 eyes) who underwent combined 25-gauge phaco-vitrectomy for idiopathic ERM and cataract, divided into capsulotomy (−) group (152 eyes, 144 patients) and capsulotomy (+) group (76 eyes, 75 patients). The main outcomes were rate of posterior capsular opacity (PCO) occurrence and postoperative complications. Ophthalmic examinations were performed at baseline, 1, 3, 6, and 12 months postoperatively. Results PCO only occurred in capsulotomy (−) group (20 eyes, 13.2%), with mean onset of 10.59 months. Visually-significant PCO that needed Nd:YAG posterior capsulotomy was present in 9 eyes (45.0% of PCO eyes). The rate of cystoid macular edema (CME) was higher in capsulotomy (+) group (6.6% vs. 15.8%, p = 0.026) with longer duration (1.50 vs. 3.36 months, p = 0.019). Female sex and posterior capsulotomy were significant risk factors for CME occurrence (p < 0.05). Conclusion Primary posterior capsulotomy during phaco-vitrectomy for idiopathic ERM obviated the need for Nd:YAG posterior capsulotomy, but visually-significant PCO that needed Nd:YAG laser was not common. Considering the low rate of visually-significant PCO and high rate of postoperative CME, routine posterior capsulotomy during phaco-vitrectomy may not be necessary for preventing PCO in ERM.

Changes of Visual Acuity and Macular Thickness after Phacovitrectomy with Posterior Capsulectomy of Epiretinal Membrane

Purpose: To investigate the functional and structural recovery period of idiopathic epiretinal membranes after phacovitrectomy with posterior capsulectomy.Methods: From March 2012 to January 2015, 57 patients diagnosed with idiopathic epiretinal membranes with cataracts who underwent combined vitrectomy and cataract surgery with pars plana posterior capsulectomy were enrolled. The best-corrected visual acuity and central foveal thickness were analyzed retrospectively.Results: The average best-corrected visual acuity before surgery was 0.30 ± 0.23 logarithm of minimal angle of resolution (logMAR), and the mean central foveal thickness was 442 ± 93 μm. As of the 12-month follow-up, the average postoperative best-corrected visual acuity had improved to 0.08 ± 0.11 logMAR, and the central foveal thickness after surgery had decreased to 386 ± 58 μm at 12 months.Conclusions: After removing the potential influence of cataracts and posterior capsular opacity, the recovery of idiopathic epiretinal membranes continued up to 12 months after surgery.

Frequency of Raised Intraocular Pressure and its Correlations to the energy used following Neodymium YAG Laser Posterior Capsulotomy in Pseudophakes

Objective: To determine the frequency of raised intraocular pressure in pseudophakic undergoing Nd YAG laser posterior capsulotomy. To compare the frequency of raised intraocular pressure in pseudophakic undergoing high and low energy Nd YAG laser posterior capsulotomy Methods: This Descriptive case series included 140 patients with pseudophakic posterior capsular opacity. After dilating the pupils with tropicamide Nd YAG laser posterior capsulotomy was performed and the total amount of energy used was noted. The frequency of raised IOP in post-laser patients and comparison of frequencies of raised IOP undergoing high and low energy Nd YAG laser posterior capsulotomies (≤ 50 MJ labeled as low energy and > 50 MJ labeled as high energy) were calculated Results: The mean age was 57.37 ±8.74. Mean pre laser IOP was 15.15 and post-laser IOP was 17.50. The rise in IOP was normal in 82.9% and raised in 17.1%. In lower energy group normal IOP was found in 35.7% and raised in 2.9%. In a higher energy group, normal IOP was found in 47.1%, and raised IOP was found to be 14.3%. Conclusion: Higher the energy used during the Nd YAG laser posterior capsulotomy procedure, more is the chance of a rise in post-laser intraocular pressure as compared to those in which lesser energy was being used.

Determinants of posterior capsular opacity after cataract surgery: a cross-sectional study

Background: Posterior capsular opacification (PCO) which is also known as “after cataract” or “secondary cataract”, is the most common complication of cataract surgery, with an incidence of 20-50%. The current study was conducted in a tertiary hospital of Odisha with an objective to find out the determinants of PCO among patients with defective vision attending the outdoor patient department of Ophthalmology.Methods: A hospital based descriptive study was conducted among the patients attending the ophthalmology out patient department of a tertiary hospital of Odisha. The detail history regarding the type of surgical procedure used for cataract extraction and the type of Intra Ocular Lens (IOL) implanted, duration of post-operative period was collected from the available documents and ophthalmic examination of the participants.Results: In the present study, 184 participants were included and examined. Fifty percent of the participants had undergone conventional extra capsular cataract extraction procedure. In 86.95% participants, the IOL used was Poly Methyl Methacrylate lens (PMMA). In 26.08% of the participants the development of PCO was within 12 to 36 months of cataract surgery. The average duration of PCO development recorded for participants <20 years was 3 months.Conclusions: Most of the participants included in the study with PCO had undergone conventional ECCE surgery, implanted PMMA lens, IOL with round edge and had a duration of 12-36 months between cataract surgery and PCO development. The average duration of PCO development is less among younger participants which gradually increases with increase in age.

Application of Spectral Domain Optical Coherence Tomography to Objectively Evaluate Posterior Capsular Opacity In Vivo

Objectives. To objectively evaluate posterior capsular opacification (PCO) with RTVue-100 spectral domain-OCT and assess the agreement with the Pentacam system. Methods. Sixty-seven eyes diagnosed with PCO were included. RTVue-100 SD-OCT was used to scan the IOL outline and PCO at horizontal and vertical meridians. PCO was also imaged with a Pentacam and slit-lamp photography system. With RTVue-100 SD-OCT, the PCO area, thickness, density, and objective scores were recorded and used to evaluate the severity of PCO at 3 mm and 5 mm diameter ranges of the IOL optic region. We assessed the correlation of visual acuity, PCO characteristics, and PCO scores. PCO scores acquired from RTVue-100 SD-OCT images were also compared with those from the Pentacam. Differences between pear-type and fibrosis-type PCOs were also compared using RTVue-100 SD-OCT cross-sectional images. Results. The cross-sectional images of PCO acquired with RTVue-100 SD-OCT corresponded well to Pentacam and slit-lamp retroillumination images. IOL-posterior capsular space, area, thickness, and density of the proliferated and accumulated LECs could be clearly visualized and quantified with RTVue-100 SD-OCT. PCO scores were correlated with decreased visual acuity, which was in line with the outcomes using the Pentacam. Differences between the pear-type and fibrosis-type PCO were statistically significant; pear-type PCOs showed a wider and thicker opacification region with lower density compared with fibrosis-type PCOs. Conclusion. RTVue-100 SD-OCT could be a powerful tool in PCO objective evaluation and classification. OCT could be used to visualize the morphology and outline of PCO. Thus, it could discriminate and quantify differences between different types of PCO. PCO scores seem to be a useful factor that could reliably reflect PCO severity.

Incidence of primary peripheral posterior capsular opacification after cataract surgery and posterior capsular opacification in the patients implanted with foldable intraocular lenses

Introduction: Preexisting posterior capsular opacification is commonly seen in the developing world due to late presentation of patients for cataract surgery. Patients are implanted with either hydrophilic or hydrophobic IOL. Effect of these IOLs on pre-existing posterior capsular opacification has not yet been reported.Aim: To determine the incidence of peripheral preexisting posterior capsular opacity (PPPCO) in patients undergoing cataract surgery and the rate of posterior capsular opacification (PCO) following implantation of hydrophilic and hydrophobic intraocular lens (IOLs).Study design: Prospective, observational case study Setting: Tertiary eye care center in central India. Methodology: 1400 consecutive patients undergoing phacoemulsification of senile cataract between July 2009 and June 2010 discovered to have PPPCO were included in the analysis. Patients were either implanted with hydrophilic (n= 40) or hydrophobic IOL (n=40). Images of the posterior capsule immediately and 3-years postoperatively were compared. Patients were followed up for development of PCO, visual outcome at 3 years and neodymium: YAG laser posterior capsulotomy (NYLPC) rate.Results: Eighty patients were found to have PPPCO (incidence of 5.7%). 47.5% of PPPCOs were from mature senile cataracts (n = 38), 36.2% were from posterior subcapsular cataracts (n = 29) and 16.2% were from posterior polar cataracts (n = 13). NYLPC was performed in 9 patients receiving hydrophilic (22.5%) and 3 patients receiving hydrophobic IOLs (7.5%; p = 0.12). Average time to NYLPC was 18 months in the hydrophilic and 30 months in the hydrophobic group (p = 0.002). Visual outcome was satisfactory at 3-years of follow-up.Conclusion: PPPCO is a frequent occurrence in mature cataract and there is a higher incidence of PCO in PPPCO patients implanted with hydrophilic IOL than with hydrophobic IOL. Therefore, hydrophobic IOL should be considered for patients discovered to have PPPCO during cataract removal.