Management Options in Pediatric Cataract Sutureless Vitrectomy
The 25 as well as 23 gauge high-speed vitrectomes have found a growing number of applications in pediatric surgery via a pars plana approach or transcorneal approach.59,60
In a clinical series, it was found that the 25-gauge
system offers several advantages when used in infantile cataract extraction. By using this system, the surgical wounds are rendered safe and secure. Moreover, when created with a flat paracentesis knife, the incisions do not need to be closed. The authors suggested that the 25-gauge vitrectomy system appears ideally suited for the management of congenital cataract in children younger than one year.59,60
Heparin in Irrigating Solution
Heparin has been used in intraocular irrigating solutions to reduce inflammatory reactions after pediatric cataract surgery. It has
1. Birch EE, Stager DR, The critical period for surgical treatment of dense congenital unilateral cataract, Invest Ophthalmol Vis Sci, 1996;37(8):1532–1538.
2. Lambert SR, Lynn MJ, Reeves R, et al., Is there a latent period for the surgical treatment of children with dense bilateral congenital cataracts?, J AAPOS, 2006;10(1):30–36.
3. Andreo LK, Wilson ME, Apple DJ, Elastic properties and scanning electron microscopic appearance of manual continuous curvilinear capsulorhexis and vitrectorhexis in an animal model of pediatric cataract, J Cataract Refract Surg, 1999;25:534–539.
4. Nischal KK, Two-incision push–pull capsulorhexis for pediatric cataract surgery, J Cataract Refract Surg, 2002;28:593–595.
5. Comer RM, Abdulla N, O’Keefe M, Radiofrequency diathermy capsulorhexis of the anterior and posterior capsules in pediatric cataract surgery: preliminary results, J Cataract Refract Surg, 1997;23(Suppl. 1):641–644.
6. Singh D, Singh RJT, Applications of the Fugo blade. In: Wilson ME, Trivedi RH, Pandey SK, Pediatric Cataract Surgery: Techniques, Complications, and Management, Philadelphia: Lippincott, Williams & Wilkins, 2005;97–100.
7. Wilson ME Jr, Trivedi RH, Bartholomew LR, Pershing S, Comparison of anterior vitrectorhexis and continuous curvilinear capsulorhexis in pediatric cataract and intraocular lens implantation surgery: a 10-year analysis, J AAPOS, 2007;11(5):443–446.
8. Parks MM, Posterior lens capsulectomy during primary cataract surgery in children, Ophthalmology, 1983;90:344–345.
9. Knight-Nanan D, O’Keefe M, Bowell R, Outcomes and complications of intraocular lenses in children with cataract, J Cataract Refract Surg, 1996;22:730–736.
10. BenEzra D, Cohen E, Posterior capsulectomy in pediatric cataract surgery; the necessity of a choice, Ophthalmology, 1997;104:2168–2174.
11. Sharma N, Pushkar N, Dada T, et al., Complications of pediatric cataract surgery and intraocular lens implantation, J Cataract Refract Surg, 1999;25:1585–1588.
12. Koch DD, Kohnen T, A retrospective comparison of techniques to prevent secondary cataract formation following posterior chamber intraocular lens implantation in infants and children. Trans Am Ophthalmol Soc, 1997;95:351–360; discussion: 361–365.
13. Trivedi RH, Wilson ME Jr, Bartholomew LR, et al. Opacification of the visual axis after cataract surgery and single acrylic intraocular lens implantation in the first year of life, J AAPOS, 2004;8:156–164.
14. Buckley EG, Klombers LA, Seaber JH, et al., Management of the posterior capsule during pediatric intraocular lens implantation, Am J Ophthalmol, 1993;115:722–728.
15. Basti S, Ravishankar U, Gupta S, Results of a prospective evaluation of three methods of management of pediatric cataracts, Ophthalmology, 1996;103:713–720.
16. Vasavada A, Desai J, Primary posterior capsulorhexis with and without anterior vitrectomy in congenital cataracts, J Cataract Refract Surg, 1997;23(Suppl. 1):645–651.
17. Plager DA, Lipsky SN, Snyder SK, Sprunger DT, Ellis FD, Sondhi N. Capsular management and refractive error in pediatric intraocular lenses. Ophthalmology 1997; 104:600–607.
18. 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;28:113–116.
19. Fenton S, O’Keefe M, Primary posterior capsulorhexis without anterior vitrectomy in pediatric cataract surgery: longer-term outcome, J Cataract Refract Surg, 1999;25:763–767.
20. Kugelberg M, Zetterstrom C, Pediatric cataract surgery with or without anterior vitrectomy, J Cataract Refract Surg, 2002;28:1770–1773.
21. BenEzra D, Cohen E, Posterior capsulectomy in pediatric Summary
While dramatic advances have occurred in this field over the past 10 years, some technical aspects of surgery, changing refraction, and functional outcome continue to pose significant problems. Primary management of the posterior capsule is mandatory depending on the age of the child at surgery. With refinements in surgical techniques, improvisation of IOLs, and better understanding of growth of the pediatric eye, in the coming years IOL implantation is likely to become an established mode of treatment of children, even in the youngest age group. n
cataract surgery: the necessity of a choice, Ophthalmology, 1997;104:2168–2174.
22. Comer RM, Abdulla N, O’Keefe M, Radiofrequency diathermy capsulorhexis of the anterior and posterior capsules in pediatric cataract surgery: preliminary results, J Cataract Refract Surg, 1997;23(Suppl. 1):641–644.
23. Alexandrakis G, Peterseim MM, Wilson ME, Clinical outcomes of pars plana capsulotomy with anterior vitrectomy in pediatric cataract surgery, J AAPOS, 2002;6:163–167.
24. Ahmadieh H, Javadi MA, Ahmady M, et al., Primary capsulectomy, anterior vitrectomy, lensectomy, and posterior chamber lens implantation in children: limbal versus pars plana, J Cataract Refract Surg, 1999;25:768–775.
25. Praveen MR, Vasavada AR, Koul A, et al., Subtle signs of anterior vitreous face disturbance during posterior capsulorhexis in pediatric cataract surgery, J Cataract Refract Surg, 2008;34:163–167.
26. Peyman GA, Cheema R, Conway MD, Fang T, Triamcinolone acetonide as an aid to visualization of the vitreous and the posterior hyaloid during pars plana vitrectomy, Retina, 2000;20:554–555.
27. Shah SK, Vasavada V, Praveen MR, et al., Triamcinolone-assisted vitrectomy in pediatric cataract surgery, J Cataract Refract Surg, 2009;35:230–232.
28. Dahan E, Salmenson BD, Pseudophakia in children: precautions, technique, and feasibility, J Cataract Refract Surg, 1990;16:75–82.
29. Gimbel HV, Ferensowicz M, Raanan M, DeLuca M, Implantation in children, J Pediatr Ophthalmol Strabismus, 1993;30:69–79.
30. Oliver M, Milstein A, Pollack A, Posterior chamber lens implantation in infants and juveniles, Eur J Implant Refract Surg, 1990;2:309–314.
31. Vasavada A, Chauhan H, Intraocular lens implantation in infants with congenital cataracts, J Cataract Refract Surg, 1994;20:592–598.
32. O’Keefe M, Fenton S, Lanigan B, Visual outcomes and complications of posterior chamber intraocular lens implantation in the first year of life, J Cataract Refract Surg, 2001;27:2006–2011.
33. Hosal BM, Biglan AW, Risk factors for secondary membrane formation after removal of pediatric cataract, J Cataract Refract Surg, 2002;28:302–309.
34. Jensen AA, Basti S, Greenwald MJ, Mets MB, When may the posterior capsule be preserved in pediatric intraocular lens surgery?, Ophthalmology, 2002;109:324–327; discussion: 328.
35. Stager DR Jr, Weakley DR Jr, Hunter JS, Long-term rates of PCO following small incision foldable acrylic intraocular lens implantation in children, J Pediatr Ophthalmol Strabismus, 2002;39:73–76.
36. Astle WF, Alewenah O, Ingram AD, Paszuk A, Surgical outcomes of primary foldable intraocular lens implantation in children: understanding posterior opacification and the absence of glaucoma, J Cataract Refract Surg, 2009;35:1216–1222.
37. Ram J, Brar GS, Kaushik S, et al., 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;29:1579–1584.
38. Raina UK, Mehta DK, Monga S, Arora R, Functional outcomes of acrylic intraocular lenses in pediatric cataract surgery, J Cataract Refract Surg, 2004;30:1082–1091.
39. Vasavada AR, Trivedi RH, Nath VC, Visual axis opacification after AcrySof intraocular lens implantation in children, J Cataract Refract Surg, 2004;30:1073–1081, erratum: 1826.
40. Aasuri MK, Fernandes M, Pathan PP, Comparison of acrylic and polymethyl methacrylate lenses in a pediatric population, Indian J Ophthalmol, 2006;54:105–109.
41. Nihalani BR, Vasavada AR, Single-piece AcrySof intraocular lens implantation in children with congenital and developmental cataract, J Cataract Refract Surg, 2006;32:1527–1534.
42. Trivedi RH, Wilson ME Jr, Single-piece acrylic intraocular lens implantation in children, J Cataract Refract Surg, 2003;29:1738–1743.
43. Gimbel HV, DeBroff BM, Posterior capsulorhexis with optic capture: maintaining a clear visual axis after pediatric cataract surgery, J Cataract Refract Surg, 1994;20:658–664.
44. Gimbel HV, DeBroff BM, Intraocular lens optic capture, J Cataract Refract Surg, 2004;30:200–206.
45. Gimbel HV, Posterior continuous curvilinear capsulorhexis and optic capture of the intraocular lens to prevent secondary opacification in pediatric cataract surgery, J Cataract Refract Surg, 1997;23(Suppl. 1):652–656.
46. Vasavada AR, Trivedi RH, Role of optic capture in congenital cataract and intraocular lens surgery in children, J Cataract Refract Surg, 2000;26:824–831.
47. Vasavada AR, Trivedi RH, Singh R, Necessity of vitrectomy when optic capture is performed in children older than 5 years, J Cataract Refract Surg, 2001;27:1185–1193.
48. Argento C, Badoza D, Ugrin C, Optic capture of the AcrySof intraocular lens in pediatric cataract surgery, J Cataract Refract Surg, 2001;27:1638–1642.
49. Dada T, Dada VK, Sharma N, Vajpayee RB, Primary posterior capsulorhexis with optic capture and intracameral heparin in paediatric cataract surgery, Clin Experiment Ophthalmol, 2000;28:361–363.
50. Enapace R, Posterior capsulorhexis combined with optic buttonholing: an alternative to standard in-the-bag implantation of sharp-edged intraocular lenses? A critical analysis of 1000 consecutive cases, Graefes Arch Clin Exp Ophthalmol, 2008;246:787–801.
51. 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;31:886–894.
52. Maloof A, Neilson G, Milverton EJ, Pandey SK, Selective and specific targeting of lens epithelial cells during cataract surgery using sealed-capsule irrigation, J Cataract Refract Surg, 2003;29:1566–1568.
53. Agarwal A, Agarwal S, Agarwal A, Maloof A, Sealed-capsule irrigation device, J Cataract Refract Surg, 2003;29:2274–2276.
54. Crowston JG, Healey PR, Hopley C, et al., Water-mediated lysis of lens epithelial cells attached to lens capsule, J Cataract Refract Surg, 2004;30:1102–1106.
55. Abdelwahab MT, Kugelberg M, Kugelberg U, Zetterström C, After-cataract evaluation after using balanced salt solution distilled deionized water and 5-fluorouracil with a sealed-capsule irrigation device in the eyes of 4-week-old rabbits, J Cataract Refract Surg, 2006;32:1955–1960.
56. Vasavada AR, Shah SK, Praveen MR, et al., Pars plicata posterior continuous curvilinear capsulorhexis, J Cataract Refract Surg, 2011;37:221–223.
57. Tassignon MJ, De Groot V, Vrensen GF, Bag-in-the-lens implantation of intraocular lenses, J Cataract Refract Surg, 2002;28:1182–1188.
58. Tassignon MJ, De Veuster I, Godts D, et al., Bag-in-the-lens intraocular lens implantation in the pediatric eye, J Cataract Refract Surg, 2007; 33:611–617.
59. Moreno-Montañés J, Barrio-Barrio J, García-Layana A, Combined cataract surgery and 25-gauge sutureless vitrectomy for posterior lentiglobus, J Cataract Refract Surg, 2007;33:380–382.
60. Chee KY, Lam GC, Management of congenital cataract in children younger than 1 year using a 25-gauge vitrectomy system, J Cataract Refract Surg, 2009;35:720–724.
61. Rumelt S, Stolovich C, Segal ZI, Rehany U, Intraoperative enoxaparin minimizes inflammatory reaction after pediatric cataract surgery, Am J Ophthalmol, 2006;141:433–437.
been documented that infusion of enoxaparin, a low molecular weight heparin, during pediatric cataract surgery may minimize the post-operative inflammatory response.61
US OPHTHALMIC REVIEW
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