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Huang Y, Dong X, Zhang J, Wan X, Wang M, Xie L. Full-Diffractive Multifocal Intraocular Lens Posterior Optic Capture for Selected Pediatric Cataracts. J Refract Surg 2021; 37:390-397. [PMID: 34170768 DOI: 10.3928/1081597x-20210225-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the short-term outcomes of implantation of a full-diffractive multifocal intraocular lens (IOL) with optic capture for selected pediatric cataracts. METHODS In this prospective study, patients with pediatric cataract aged 3 to 14 years were selected to receive multifocal IOL (Tecnis ZMB00; Abbott Medical Optics) posterior optic capture. Visual acuity, stereopsis, visual quality, and complications were assessed. RESULTS Forty-five patients (66 eyes) were recruited with a follow-up of 9.09 ± 5.93 months (range: 6 to 24 months). The cataract was bilateral in 21 patients and unilateral in 24 patients. At the last follow-up visit, the mean distance-corrected distance, intermediate, and near visual acuity was 0.28 ± 0.25, 0.43 ± 0.24, and 0.39 ± 0.27 logMAR, respectively. Among the patients with bilateral cataract, postoperative corrected distance visual acuity (CDVA) was 20/40 or better in 79% (33 of 42) of the eyes and 20/20 in 26% (11 of 42) of the eyes. Of the patients with unilateral cataract, 54% (13 of 24) achieved a CDVA of 20/40 or better but none obtained a CDVA of 20/20. All patients developed stereopsis postoperatively (P < .05). There was no significant difference in modulation transfer function cut-off and Strehl ratio between the eyes with a multifocal IOL and the healthy eyes of patients with unilateral cataract (P > .05). Objective Scatter Index values were significantly better in the healthy eyes (P < .05). No posterior capsule opacification, posterior synechiae, secondary glaucoma, pigmentary IOL deposits, or IOL decentration was observed during the follow-up period. CONCLUSIONS Short-term follow-up results suggest full-diffractive multifocal IOL optic capture may benefit appropriately selected patients with pediatric cataract. [J Refract Surg. 2021:37(6):390-397.].
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Kaur S, Sukhija J, Ram J. Comparison of posterior optic capture of intraocular lens without vitrectomy vs endocapsular implantation with anterior vitrectomy in congenital cataract surgery: A randomized prospective study. Indian J Ophthalmol 2020; 68:84-88. [PMID: 31856476 PMCID: PMC6951169 DOI: 10.4103/ijo.ijo_522_19] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To compare surgical outcome of two procedures in pediatric cataract surgery. Methods: Prospective randomised interventional study. Consecutive patients with bilateral congenital cataract who were operated during January 2016 to October 2016 at a tertiary care referral institute were included. One eye of all patients underwent Intraocular lens (IOL) implantation with optic capture through a primary posterior continuous curvilinear capsulorhexis (PPC) without vitrectomy while in the other eye endocapsular IOL implantation was performed along with PPC and anterior vitrectomy. Intraoperative challenges and postoperative complications were noted. Results: 15/18 children who fulfilled the inclusion criteria were included for follow up analysis. Mean age at the time of surgery was 21 ± 14.7 months. At a mean follow up of 25.69 ± 1.06 months; all eyes in both groups maintained a clinically centred IOL with clear visual axis. One patient with endocapsular IOL implantation developed anterior capsular phimosis. The rate of fibrinous complications (IOL deposits and synechiae) were more in the eyes with IOL in the bag (6 eyes) vs eyes where posterior optic capture was done (1 eye); P = 0.039. Conclusion: Posterior optic capture is a safer alternative to conventional pediatric cataract surgery in terms of inflammatory sequelae and lens epithelial cell proliferation. However the two methods work equally well in preventing visual axis obscuration over a long follow-up.
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Affiliation(s)
- Savleen Kaur
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaspreet Sukhija
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Vasavada AR, Vasavada V, Shah SK, Trivedi RH, Vasavada VA, Vasavada SA, Srivastava S, Sudhalkar A. Postoperative outcomes of intraocular lens implantation in the bag versus posterior optic capture in pediatric cataract surgery. J Cataract Refract Surg 2019; 43:1177-1183. [PMID: 28991614 DOI: 10.1016/j.jcrs.2017.07.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare complications in children up to 4 years old having cataract surgery with intraocular lens (IOL) implantation using 2 techniques: in-the-bag IOL with anterior vitrectomy or optic capture of IOL with no anterior vitrectomy. SETTING Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN Prospective randomized control clinical trial. METHODS The study included children having cataract surgery with IOL implantation. Patients were randomized to Group 1 (in-the-bag 3-piece hydrophobic acrylic IOL [Acrysof MA60AC] with anterior vitrectomy) or Group 2 (optic capture of the same IOL without anterior vitrectomy). Intraoperative complications were documented. Postoperative visual axis obscuration (VAO), glaucoma, cell deposits on the IOL, and posterior synechiae were compared at 1, 3, 6, and 12 months. RESULTS The study comprised 61 children (61 eyes). The mean ages were 14.8 months ±11.47 (SD) in Group 1 (n = 30) and 18.2 ± 11.47 months in Group 2 (n = 31). Overall, only 1 eye in Group 1 developed a VAO requiring membranectomy 4 months postoperatively, and 2 eyes in Group 1 developed glaucoma over 12 months (P = .49). Intraocular lens cell deposits and posterior synechiae were comparable between groups. The IOL could not be captured in 5 eyes (16.1%); no complications occurred in these eyes. CONCLUSIONS Optic capture of 3-piece hydrophobic acrylic IOLs could be achieved in most eyes. The VAO, glaucoma, and inflammation were comparable 12 months postoperatively. Thus, optic capture of an IOL is an alternative surgical technique that can be used to avoid vitrectomy, even in children younger than 4 years.
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Affiliation(s)
- Abhay R Vasavada
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Vaishali Vasavada
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sajani K Shah
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rupal H Trivedi
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Viraj A Vasavada
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shail A Vasavada
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Samaresh Srivastava
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aditya Sudhalkar
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
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Xie YB, Ren MY, Wang Q, Wang LH. Intraocular lens optic capture in pediatric cataract surgery. Int J Ophthalmol 2018; 11:1403-1410. [PMID: 30140648 DOI: 10.18240/ijo.2018.08.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/27/2018] [Indexed: 12/28/2022] Open
Abstract
Posterior capsule opacification (PCO) remains the most common complication of pediatric cataract surgery despite continuous efforts to reduce its incidence. For this reason, pediatric cataract surgeons have expended considerable effort into preventing and mitigating PCO. The intraocular lens (IOL) optic capture technique has been used for the prevention of PCO after pediatric cataract surgery for more than 20y, but there is still no professional consensus. However, recent research has shown encouraging results. The IOL optic capture technique can be performed without anterior vitrectomy to prevent PCO, even in younger children. The type and characteristics of IOLs used for optic capture technique, the location of IOL and the complications of IOL optic capture in children are here reviewed.
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Affiliation(s)
- Ying-Bin Xie
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Mei-Yu Ren
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Qi Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Li-Hua Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
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Lotfy A, Abdelrahman A. Trypan blue-assisted posterior capsulorhexis in pediatric cataract surgery. Clin Ophthalmol 2017; 11:219-222. [PMID: 28182152 PMCID: PMC5279846 DOI: 10.2147/opth.s123150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of staining the posterior capsule with trypan blue during capsulorhexis in pediatric cataract surgery. PATIENTS AND METHODS This was a prospective randomized comparative study carried out at Alpha Vision Center, Zagazig, Egypt. This study included 2 groups of children with pediatric cataract randomly allocated to undergo irrigation and aspiration. In the trypan group, which included 11 eyes, trypan blue was used to stain the posterior capsule during posterior capsulorhexis. In the control group, which included 10 eyes, no staining was performed. All surgeries were performed by the same surgeon. The 2 groups were compared for criteria such as completion of capsulorhexis, disruption of vitreous face and in-the-bag intraocular lens implantation. RESULTS This study included 21 eyes of 16 patients (age range: 6 months-4 years). A statistically significant difference was observed for the following parameters between the 2 groups: capsulorhexis completion (P=0.04), vitreous face disruption (P=0.01) and in-the-bag intraocular lens implantation (P=0.022). CONCLUSION This study suggests that staining of the posterior capsule during capsulorhexis in pediatric cataract operation gives better results than capsulorhexis without staining. The stain changes the capsule texture making capsulorhexis easier with fewer complications.
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Affiliation(s)
- Ayman Lotfy
- Ophthalmology Department, Zagazig University Hospital
- Alpha Vision Center, Zagazig, Egypt
| | - Ayman Abdelrahman
- Ophthalmology Department, Zagazig University Hospital
- Alpha Vision Center, Zagazig, Egypt
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Vasavada AR, Vasavada V. Current Status of IOL implantation in pediatric eyes: an update. Expert Rev Med Devices 2017; 14:1-9. [PMID: 28042714 DOI: 10.1080/17434440.2016.1271706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/09/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Pediatric cataracts are a huge problem worldwide, and with improving techniques and technology, the surgical treatment and postoperative visual rehabilitation are improving. Despite intraocular lenses(IOLs) being the standard of care for adult cataract surgery, this issue is still somewhat controversial, particularly in young children and infants due to lack of unequivocal evidence. This review therefore summarises the findings from recent studies on the aspect of IOL implantation in pediatric eyes. Areas covered: An extensive literature search was undertaken for published articles on congenital/developmental pediatric cataracts, and IOL implantation, where literature pertinent to traumatic and subluxated cataracts was not included in the review. Pubmed was used for literature search, and keywords entered were : pediatric, cataract surgery, intraocular lens, persistent fetal vasculature, outcomes, complications, visual performance with intraocular lenses. Expert commentary: Recent literature supports IOL implantation in most cases of congenital / developmental pediatric cataracts, and it seems like the way forward. However, the jury is still out on IOL implantation in infants, particularly in bilateral cataracts. Thus, surgeons must be extremely cautious in planning primary IOL implantation in infant eyes, and if they do perform IOL implantation, rigorous followup is mandatory.
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Affiliation(s)
- Abhay R Vasavada
- a Iladevi Cataract & IOL Research Centre, Raghudeep Eye Hospital , Ahmedabad , India
| | - Vaishali Vasavada
- a Iladevi Cataract & IOL Research Centre, Raghudeep Eye Hospital , Ahmedabad , India
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Kleinmann G, Zaugg B, Apple DJ, Bleik J. Pediatric cataract surgery with hydrophilic acrylic intraocular lens. J AAPOS 2013; 17:367-70. [PMID: 23928003 DOI: 10.1016/j.jaapos.2013.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 03/23/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the outcomes after hydrophilic acrylic intraocular lens (IOL) implantation during pediatric cataract surgery. METHODS This was a retrospective chart review of children who underwent cataract surgery or secondary IOL implantation at Beirut Eye Specialist Centre, Rizk Hospital, between March 2002 and August 2007. RESULTS A total of 57 eyes of 40 patients (20 boys) were included in this study. The average age at surgery was 48 ± 40 months (range, 5-172 months). Of these, 54 eyes had congenital or developmental cataracts and 3 eyes had traumatic cataracts. Primary cataract removal and IOL implantation accounted for 45 surgeries, and secondary IOL implantation accounted for 12 surgeries. Hydrophilic acrylic IOLs were implanted in all surgeries. Average follow-up time was 47 ± 21 months (range, 9-97 months). No intraoperative complications were recorded. Of the 57 eyes, 12 (21%) had postoperative complications, but only 7 (12%) required secondary intervention. Average best-corrected visual acuity improved from 2.0 ± 1.0 logMAR preoperatively to 0.8 ± 1.0 logMAR at last follow-up. Improved visual acuity was observed in 47 eyes (82.5%); 31 eyes (54.4%) had a visual acuity of ≥ 20/40 at the last follow-up. CONCLUSIONS Hydrophilic acrylic IOLs appear to be suitable for use in pediatric cataract surgery. Results from this study suggest that, compared with hydrophobic IOLs, these IOLs produce similar complication rates, secondary intervention rates, and visual acuity results.
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Affiliation(s)
- Guy Kleinmann
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah.
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Posterior capsule management in congenital cataract surgery. J Cataract Refract Surg 2011; 37:173-93. [PMID: 21183112 DOI: 10.1016/j.jcrs.2010.10.036] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 06/17/2010] [Accepted: 06/26/2010] [Indexed: 11/20/2022]
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Tassignon MJ, Gobin L, De Veuster I, Godts D. [Advantages of the bag-in-the-lens intraocular lens in pediatric cataract surgery]. J Fr Ophtalmol 2009; 32:481-7. [PMID: 19717210 DOI: 10.1016/j.jfo.2009.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 06/26/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the advantages of the bag-in-the-lens intraocular lens in children undergoing cataract surgery. PATIENTS AND METHODS This prospective study included 54 eyes of 37 children and babies (age, 2 months to 14 years), consecutively operated on between December 1999 and January 2008 for unilateral or bilateral cataract using the "bag-in-the-lens" intraocular lens. Slit-lamp examination, intraocular pressure, visual acuity, and refraction were followed to the best possible degree over time. RESULTS The mean age of the 37 children at the last consultation visit was 8.3+/-4.9 years. The mean visual acuity improved from 0.2+/-0.1 to 0.8+/-0.3. On the other hand, visual acuity improvement in children presenting hyperplastic persistence of the vitreous was less favorable with a postoperative average visual acuity of 0.14+/-0.18. The mean postoperative refraction in 13 children (26 eyes) operated on for bilateral cataract was 0.5+/-1.5 D for eyes showing axial lengths with substantial variation. The refraction was stable over time in children over 2 years of age. Once the implant was positioned correctly, the remaining epithelial cells of the lens did not migrate toward the visual axis, which was the case in 93.8% of all eyes and in 100% of children over 1 year of age. CONCLUSIONS The "bag-in-the-lens" implant is particularly indicated in children in whom posterior rhexis and optic capture have been recommended since 1994. The implantation minimizes the use of anterior vitrectomy in pediatric cataract surgery, limiting it to those eyes presenting a proliferative hyperplastic vitreous.
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Affiliation(s)
- M-J Tassignon
- Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium.
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Luo Y, Lu Y, Lu G, Wang M. Primary posterior capsulorhexis with anterior vitrectomy in preventing posterior capsule opacification in pediatric cataract microsurgery. Microsurgery 2008; 28:113-6. [PMID: 18220313 DOI: 10.1002/micr.20460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Our study was performed to investigate the operative effects of pediatric cataract surgery with anterior vitrectomy. The study comprised of 38 pediatric patients aged 2-5 years and involved a total of 60 eyes with congenital cataracts. The study was done between March 2004 and December 2005. Posterior capsulorhexis with anterior vitrectomy was performed on 34 eyes of 20 children, and cataract extraction was performed on 26 eyes of 18 children. The percentages of various complications and rate of neodymium YAG (Nd:YAG) laser capsulotomy were followed up for 12-36 months. There were significant differences in the percentages of posterior capsule opacification (PCO) and rate of neodymium YAG (Nd:YAG) capsulotomy between the anterior vitrectomy group and cataract extraction group (P < 0.01). The anterior vitrectomy group was associated with less posterior capsular opacification (11.8%) than the cataract extraction group (76.9%). The YAG capsulotomy rate was 2.9% for the anterior vitrectomy group, and 57.7% for the cataract extraction group. After operation the fibrous exudates in anterior chamber and the intraocular lens subluxation or capture were 5.9% and 2.9% for the anterior vitrectomy group while for the cataract extraction group they were 23.1% and 15.4%; the difference was statistically significant (P < 0.05). The results suggest that primary posterior capsulorhexis with anterior vitrectomy in pediatric cataract surgery who are between 2 and 5 years old is necessary and effective procedure with low PCO rate.
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Affiliation(s)
- Yi Luo
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
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Wilson ME, Trivedi RH, Buckley EG, Granet DB, Lambert SR, Plager DA, Sinskey RM, Vasavada AR. ASCRS white paper. Hydrophobic acrylic intraocular lenses in children. J Cataract Refract Surg 2007; 33:1966-73. [PMID: 17964406 DOI: 10.1016/j.jcrs.2007.06.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 05/08/2007] [Indexed: 10/22/2022]
Affiliation(s)
- M Edward Wilson
- MUSC--Storm Eye Institute, 167 Ashley Avenue, Charleston, South Carolina 29425-5536, USA.
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Tassignon MJ, De Veuster I, Godts D, Kosec D, Van den Dooren K, Gobin L. Bag-in-the-lens intraocular lens implantation in the pediatric eye. J Cataract Refract Surg 2007; 33:611-7. [PMID: 17397732 DOI: 10.1016/j.jcrs.2006.12.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 12/19/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the efficacy, safety, and feasibility of implantation of a bag-in-the-lens intraocular lens (IOL) in children and babies. SETTING Departments of Ophthalmology, University Hospital, Antwerp, Belgium, and the University Hospital, Ljubljana, Slovenia, and a private ophthalmology practice, Oudenaarde, Belgium. METHODS Thirty-four eyes of 22 children had implantation of a bag-in-the-lens IOL. The ages ranged from 2 months to 14 years. Congenital cataract was present in 26 eyes, and persistent fetal vasculature (PFV) was concomitantly present in 4 eyes. Fifteen patients had bilateral cataract, and 6 had unilateral cataract. RESULTS In 3 eyes, the IOL could not be properly implanted. In these cases, secondary intervention was necessary because of early posterior capsule opacification. The mean postoperative follow-up was 17.45 months +/- 17.12 (SD) (range 4 to 68 months). None of the children except those presenting with PFV had anterior vitrectomy during surgery. The optical axis remained clear during the follow-up in all patients who had successful IOL implantation. CONCLUSIONS The bag-in-the-lens implantation technique in children and babies was safe and kept the visual axis clear after cataract surgery. In the near future, 4.0 or 4.5 mm IOLs will be available that may improve the success rate of IOL implantation in the small eyes of babies.
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Ahn JH, Kim WS. Surgical Results and Complications of Implanted Primary Intraocular Lenses in Pediatric Cataract. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2007. [DOI: 10.3341/jkos.2007.48.9.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Hyo Ahn
- Department of Ophthalmology, Maryknoll Hospital, Pusan, Korea
| | - Wan Soo Kim
- Department of Ophthalmology, Maryknoll Hospital, Pusan, Korea
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Sharma N, Balasubramanya R, Dada VK, Vajpayee RB. Efficacy of trypan blue in posterior capsulorhexis with optic capture in pediatric cataracts [ISRCTN48221688]. BMC Ophthalmol 2006; 6:12. [PMID: 16539738 PMCID: PMC1434781 DOI: 10.1186/1471-2415-6-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2004] [Accepted: 03/16/2006] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the efficacy of trypan blue (0.06%) in posterior capsulorhexis with optic capture in pediatric cataracts. Methods In this prospective randomized controlled study, trypan blue dye assisted posterior capsulorhexis with optic capture was performed in 18 eyes (group 1) and no dye was used for posterior capsulorhexis (group 2) in 17 eyes. Results The mean size of the posterior capsulorhexis was 4.6 +/-1.77 mm and 4.0 +/- 0.93 mm in the group 1 and 2 respectively. Optic capture was possible in 17 eyes in the group 1 and 11 eyes in the group 2. Conclusion Trypan blue facilitates posterior capsulorhexis with optic capture of AcrySof IOL in cases of pediatric cataracts.
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Affiliation(s)
- Namrata Sharma
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, INDIA
| | - Ramamurthy Balasubramanya
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, INDIA
| | - Vijay K Dada
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, INDIA
| | - Rasik B Vajpayee
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, INDIA
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Grieshaber MC, Pienaar A, Stegmann R. Posterior vertical capsulotomy with optic entrapment of the intraocular lens in congenital cataracts--prevention of capsule opacification. J Cataract Refract Surg 2005; 31:886-94. [PMID: 15975452 DOI: 10.1016/j.jcrs.2004.08.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To present a modified surgical technique for preventing posterior capsule opacification (PCO) in children with congenital cataracts and to evaluate its long-term efficacy. SETTING Department of Ophthalmology, Medical University of Southern Africa, Medunsa, South Africa. METHODS Anterior and posterior vertical capsulotomy, with optic entrapment of the intraocular lens (IOL) by maintaining the anterior hyaloid, was performed in 68 cataractous eyes of children aged 2 months to 8 years (mean 3 years, 1 month). The posterior capsule was evaluated for at least 5 years for secondary opacification, IOL position, pigmentary deposits on the IOL optic, and the presence of synechias. RESULTS Sixty-eight eyes maintained a clear visual axis for 5 to 12 years (mean 9 years, 1 month) postoperatively. No secondary procedure was necessary. In all eyes, the IOL remained well centered and entrapped. CONCLUSIONS Posterior capsulotomy with optic entrapment of the IOL proved to be a safe and efficient surgical procedure for preventing PCO in children with congenital cataracts. Uniting the anterior and posterior capsule in front of the IOL limits the proliferation and migration of Elschnig pearls. An intact anterior hyaloid does not induce capsule opacification in association with optic entrapment; therefore, a vitrectomy is not indicated even in infants under age 5 years. Clear visual axis, centered IOL, and intact vitreous were achieved in this series; this enables a promising long-term prognosis for binocular visual development, especially because surgery was performed early.
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Affiliation(s)
- Matthias C Grieshaber
- Department of Ophthalmology, Medical University of Southern Africa, Medunsa, South Africa.
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Abstract
Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is nonprogressive, whereas lamellar cataract usually develops later and is progressive. Surgery must be performed promptly in cases with dense congenital cataract; if nystagmus has developed, the amblyopia is irreversible. A treatment regimen based on surgery within 2 months of birth combined with prompt optical correction of the aphakia and aggressive occlusion therapy with frequent follow-up has been successful in unilateral and bilateral cases. Both anterior and posterior capsulorhexes are performed in most children. Intraocular lens implantation can be performed safely in children older than 1 year. Anterior dry vitrectomy is recommended in preschool children to avoid after-cataract. Opacification of the visual axis is the most common complication of cataract surgery in children. Secondary glaucoma is the most sight-threatening complication and is common if surgery is performed early. Life-long follow-up is essential in these cases.
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Kugelberg M, Kugelberg U, Bobrova N, Tronina S, Zetterström C. After-cataract in children having cataract surgery with or without anterior vitrectomy implanted with a single-piece AcrySof IOL. J Cataract Refract Surg 2005; 31:757-62. [PMID: 15899453 DOI: 10.1016/j.jcrs.2004.08.044] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye. SETTING Filatov Institute, Odessa, Ukraine. METHODS Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed. RESULTS Children in the younger age group (</=62 months at surgery) had surgery for after-cataract more often than children in the older age group (P<.01). Patients who did not receive an anterior vitrectomy had surgery for after-cataract more often (P<.01). Age at surgery and whether an anterior vitrectomy was performed did not significantly affect the EPCO score. The patients who had surgery for after-cataract had a significantly higher EPCO score (P<.001). The IOL remained centered in all eyes; no eye developed posterior synechias. CONCLUSIONS This prospective study shows that cataract surgery with anterior vitrectomy is advantageous in younger patients concerning after-cataract formation. The AcrySof SA30AL maintains good centration, produces minimal inflammation, and is well tolerated in the pediatric eye.
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Wilson EM, Trivedi RH. Single-piece acrylic intraocular lens implantation in children. J Cataract Refract Surg 2004. [DOI: 10.1016/j.jcrs.2004.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vasavada AR, Trivedi RH, Nath VC. Visual axis opacification after AcrySof intraocular lens implantation in children. J Cataract Refract Surg 2004; 30:1073-81. [PMID: 15130646 DOI: 10.1016/j.jcrs.2003.08.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate visual axis opacification after AcrySof intraocular lens (IOL) (Alcon) implantation in pediatric eyes. SETTING Iladevi Cataract and IOL Research Centre, Ahmedabad, India. METHODS This prospective study evaluated 103 consecutive eyes of 72 children with congenital cataract. Two groups were formed based on age at surgery: Group 1, younger than 2 years, and Group 2, older than 2 years. All eyes in Group 1 (n = 37) had primary posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy. In Group 2 (n = 66), management of the posterior capsule was assigned randomly to no PCCC (Group 2A, n = 37) or PCCC (Group 2B, n = 29). The PCCC group was further randomized into 2 subgroups: no vitrectomy (Group 2BN, n = 14) or vitrectomy (Group 2BV, n = 15). The primary outcome measures were visual axis opacification and the resulting need for a secondary procedure. Statistical analysis was performed using SPSS for Windows (version 11.0.1). RESULTS The mean age of the patients was 5.2 years +/- 5.0 (SD) (range 0.2 to 16.0 years) and the mean follow-up, 2.3 +/- 0.9 years (range 1.0 to 4.0 years). Overall, 41 eyes (39.8%) developed visual axis opacification and 14 (13.6%) required secondary intervention. In Group 1, 4 eyes (10.8%) developed visual axis opacification and 3 (8.1%) had a secondary pars plana vitrectomy. In Group 2A, 31 eyes (83.8%) developed posterior capsule opacification (PCO) and 10 eyes (27.7%) had secondary intervention. Children 8 years or younger at the time of surgery developed significantly greater PCO than older children (P =.01). Five eyes (37.5%) in Group 2BN had opacification of the anterior vitreous face, 1 of which required a secondary procedure. One eye (6.7%) in Group 2BV had visual axis opacification that did not require a secondary procedure. CONCLUSIONS AcrySof IOL implantation with appropriate management of the posterior capsule maintained a clear visual axis in 60.2% of eyes. Of the 39.8% of eyes with visual axis opacification, 13.6% had visually significant opacification and required a secondary procedure.
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Raina UK, Mehta DK, Monga S, Arora R. Functional outcomes of acrylic intraocular lenses in pediatric cataract surgery. J Cataract Refract Surg 2004; 30:1082-91. [PMID: 15130647 DOI: 10.1016/j.jcrs.2003.11.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2003] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the functional outcomes of in-the-bag implantation of acrylic intraocular lenses (IOLs) with posterior continuous curvilinear capsulorhexis (PCCC), without PCCC, with PCCC and anterior vitrectomy, and with PCCC and optic capture in pediatric cataract surgery. SETTING Pediatric Ophthalmology Service, Guru Nanak Eye Centre, New Delhi, India. METHODS Forty-two eyes of 25 children were included in this prospective study. All eyes had in-the-bag implantation of an AcrySof IOL (Alcon). Twenty-five eyes had had an anterior continuous curvilinear capsulorhexis (ACCC) (Group A). Seventeen eyes had PCCC along with ACCC (Group B), 4 had anterior vitrectomy combined with PCCC (Group C), and 6 had PCCC with IOL optic capture through the PCCC (Group D). Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. RESULTS The mean age of the patients was 78 months (range 36 to 144 months). The mean follow-up was 13 months (range 6 to 18 months). Four eyes (16%) in Group A developed visually significant posterior capsule opacification (PCO) involving the central visual axis and required secondary capsulotomy. All eyes in Groups B, C, and D had a clear visual axis at the last follow-up and did not require a secondary procedure. Minimal postoperative inflammation (ie, aqueous flare and IOL deposits ) was seen in all groups. The mean preoperative decimal best corrected visual acuity (BCVA) in Groups A, B, C, and D was 0.095, 0.055, 0.174, and 0.039, respectively. Postoperatively, the BCVA was 0.54, 0.66, 0.66, and 0.66, respectively. CONCLUSIONS An optimal-sized ACCC followed by in-the-bag implantation of a foldable acrylic IOL helped maintain a clear visual axis by delaying the onset of PCO and leading to milder PCO. The benefits of a foldable acrylic IOL in pediatric cataract surgery can be increased by combining it with PCCC, with or without anterior vitrectomy, or with optic capture of the IOL.
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Affiliation(s)
- Usha K Raina
- Pediatric Ophthalmology Service, Guru Nanak Eye Center, Maulana Azad Medical College, New Delhi, India
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Trivedi RH, Wilson ME, Bartholomew LR, Lal G, Peterseim MM. Opacification of the visual axis after cataract surgery and single acrylic intraocular lens implantation in the first year of life. J AAPOS 2004; 8:156-64. [PMID: 15088050 DOI: 10.1016/j.jaapos.2003.10.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the incidence and risk factors for secondary surgical intervention to treat visual axis opacification (VAO) after cataract surgery and acrylic intraocular lens (IOL) implantation during the first year of life. METHODS A retrospective review of 29 eyes of 20 patients receiving a hydrophobic acrylic (AcrySof; Alcon, Fort Worth, TX) IOL implantation was conducted. All eyes underwent primary posterior capsulectomy and anterior vitrectomy. Statistical analysis was performed using SPSS for Windows (SPSS, Chicago, IL). RESULTS Average age at surgery was 4.8 +/- 3.7 months, and average follow-up was 33.4 +/- 16.1 months. Eleven of 29 (37.9%) eyes developed VAO requiring secondary surgical intervention at a median of 4.8 months (95% confidence interval 3.4 to 6.2). Average age at surgery for eyes that subsequently opacified was 3.8 +/- 3.0 months compared with 5.4 +/- 4.0 months for those whose visual axis remained clear (P = 0.26). The relative risk of subsequent VAO surgery was 2.7 for primary surgery performed at or before the first 6 months of life. Opacification was significantly related to eyes with associated ocular anomalies (eg, anterior segment dysgenesis, iris hypoplasia, or persistent fetal vasculature) with a relative risk of 8.6 (P < 0.001). Proliferation of cortex was the most common form of VAO, followed by mixed-type with predominantly fibrous, fibrous alone, or Elschnig pearls. When secondary surgery was required, it occurred primarily during the first 6 months (ie, 9 of 11 patients) after the initial cataract surgery. CONCLUSIONS When cataract and IOL surgery was undertaken within the first year of life, a secondary surgical procedure was required in 37.9% of eyes to maintain a clear visual axis. Most secondary surgery for VAO occurred within the first 6 months after surgery. Postoperative opacification was most common in eyes with associated ocular anomalies.
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Affiliation(s)
- Rupal H Trivedi
- Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, 167 Ashley Avenue, Charleston, SC 29425-5536, USA
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Abstract
A continuous curvilinear capsulorhexis (CCC) provides a tear-resistant opening that allows use of a technique of capturing the intraocular lens (IOL) optic through the capsulorhexis opening when the opening is at least 1.0 to 2.0 mm smaller than the optic diameter. The technique provides stability and long-term centration of the IOL and prevents vitreous from extending anterior to the IOL. This paper reviews the current variations of optic capture including (1) haptics in the sulcus and IOL optic capture through a CCC, (2) haptics in the sulcus and IOL optic capture through an anterior capsule opening and a posterior CCC (PCCC), (3) haptics in the capsular bag and IOL optic capture through a PCCC, (4) haptics in the capsular bag and IOL optic capture through an anterior CCC, (5) haptics in the sulcus and IOL capture through a capsular membrane opening, and (6) haptics posterior to the capsular bag and IOL capture through a capsular membrane opening.
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Abstract
PURPOSE To assess the short-term outcomes of single-piece acrylic intraocular lens (IOL) implantation in children by determining the incidence of postoperative visual axis opacification and the need for a second procedure to clear the axis, cell deposits on the IOL optic, posterior synechias, and IOL decentration. SETTING Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS This retrospective case review comprised 43 consecutive implantations (33 patients) of a single-piece hydrophobic acrylic IOL (AcrySof SA30AL or SA60AT, Alcon). An analysis of 42 eyes with posterior capsulectomy and vitrectomy was performed. Eyes with traumatic cataract and secondary IOLs were excluded. RESULTS Single-piece acrylic IOLs were implanted in 42 eyes. The mean age was 33.5 months +/- 28.9 (SD) (range 0.5 to 110 months) and the mean follow-up, 12.0 +/- 8.2 months (range 1.0 to 27.5 months). Postoperative opacification of the visual axis occurred in 7 eyes (16.7%). Secondary surgical procedures were required in 5 eyes (11.9%). Lens deposits were observed in 8 eyes (19.0%) and synechias, in 5 eyes (11.9%). All IOLs were well centered postoperatively. CONCLUSION The short-term data suggest implantation of the AcrySof single-piece hydrophobic acrylic IOL is safe in the pediatric eye.
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Affiliation(s)
- Rupal H Trivedi
- Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA
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Ram J, Brar GS, Kaushik S, Gupta A, Gupta A. Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery. J Cataract Refract Surg 2003; 29:1579-84. [PMID: 12954310 DOI: 10.1016/s0886-3350(03)00231-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the effect of primary posterior capsulotomy with anterior vitrectomy (PPC + AV) and intraocular lens (IOL) design and material on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. SETTING Tertiary care institution in India. PATIENTS Sixty-four eyes of 52 children ranging in age from 3 months to 12 years who had cataract extraction with IOL implantation were prospectively evaluated for a minimum postoperative period of 2 years. METHODS Thirty-two eyes received a hydrophobic acrylic lens with a truncated, square edge and 32, a single-piece poly(methyl methacrylate) (PMMA) lens that was not heparin surface modified. Sixteen eyes in each IOL group had PPC + AV; in the remaining 16 eyes in each group, the posterior capsule was left intact. RESULTS Postoperatively, 25 eyes in the intact capsule group and 5 in the PPC + AV group developed PCO; the difference between groups was significant (P<.05). Of eyes with an intact capsule, 12 with an acrylic IOL and 13 with a PMMA IOL developed PCO (P>.05). In the PPC + AV group, 2 eyes with an acrylic IOL and 3 with a PMMA IOL developed PCO (P>.05). Overall, 14 eyes with an acrylic lens and 16 eyes with a PMMA lens developed PCO (P>.05). After surgery, there was a significant short-term delay in the development of PCO in the acrylic group (14 eyes; mean 6.66 months +/- 1.57 [SD]) compared to the PMMA group (16 eyes; mean 3.16 +/- 0.83 months) (P<.05). CONCLUSIONS It is the management of the posterior capsule rather than IOL design and material that influences the incidence of PCO after cataract surgery in children. Development of PCO in the postoperative period was delayed with a hydrophobic acrylic IOL with square edges compared with a PMMA lens without square edges.
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Affiliation(s)
- Jagat Ram
- Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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Müllner-Eidenböck A, Amon M, Moser E, Kruger A, Abela C, Schlemmer Y, Zidek T. Morphological and functional results of AcrySof intraocular lens implantation in children: prospective randomized study of age-related surgical management. J Cataract Refract Surg 2003; 29:285-93. [PMID: 12648639 DOI: 10.1016/s0886-3350(02)01532-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the prevalence and severity of posterior capsule opacification (PCO) in pediatric eyes with a foldable acrylic AcrySof (Alcon) intraocular lens (IOL) and age-related surgical methods. SETTING Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria. METHODS This prospective randomized study comprised 50 eyes of 34 children aged between 2 and 16 years. Eyes of children between 2 and 5.9 years were consecutively randomized to Group 1a (primary posterior capsulotomy and anterior vitrectomy) or Group 1b (optic capture in addition). Eyes of children between 6 and 16 years were consecutively randomized to Group 2a (primary posterior capsulotomy without anterior vitrectomy), Group 2b (optic capture in addition), or Group 2c (in-the-bag IOL implantation without opening the posterior capsule). Main outcome parameters were the incidence and severity of PCO formation, early postoperative complications, pigmented cell deposits on the IOL surface, and cataract morphology. RESULTS The visual axis was clear at the last follow-up in all eyes in Groups 1a, 1b, 2a, and 2b except in 1 eye in Group 1a. Sixty-percent of eyes in Group 2c had PCO. The incidence of early postoperative complications was significantly higher in eyes that developed PCO than in those that maintained a clear visual axis. There was no evidence that cataract morphology influenced PCO rates. CONCLUSIONS The AcrySof IOL was well tolerated in pediatric eyes. Optic capture was not necessary to ensure a clear visual axis. Primary posterior capsulotomy should be performed in preschool and uncooperative children and in eyes expected to have relatively high postoperative inflammation. Implanting the AcrySof in the bag and leaving the posterior capsule intact is acceptable for school children and juveniles with isolated developmental cataract.
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Badoza D. Role of Vitrectomy with Optic Capture. J Cataract Refract Surg 2002. [DOI: 10.1016/s0886-3350(02)01251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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