pediatric cataract and iol surgery: current practices and controversies dr vidushi sharma & dr...

7/28/2019 Pediatric Cataract and IOL Surgery: Current Practices and Controversies Dr Vidushi Sharma & Dr Suresh K Pandey SuVi Eye Institute Kota India American Society of Cataract & Refractive Surgery (ASCRS) Instruction Course

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Pediatric Cataract Surgeryin Challenging Situations

Dr. Vidushi Sharma

MD (AIIMS, N.DELHI), FRCS (UK)

Dr Suresh K PandeyMS (PGIMER), ASF (USA)

SuVi Eye Institute & Lasik Laser Centre,Kota, RAJ., INDIAEmail- [email protected]: www.suvieye.com

NO FINANCIAL INTEREST
mailto:[email protected]://www.suvieye.com/http://www.suvieye.com/mailto:[email protected]


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Questions need to be answered

Is IOL Implantation feasible in infants

Current trends in IOL Power

Calculation Management of complex pediatric

cases (trauma, ectopia lentis, PPCD,ant. & post. lenticonus, capsular

plaques, etc)

Modalities to achieve clear visual axisand to prevent/delay VAO


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Importance

Childhood cataracts 1-15 per 10,000children

Birth prevalence of cong. bilateralcataracts 1-3 per 10,000 children in industrialized

countries

Likely to be 10 per 10,000 in developingnations

Impact much more because ofincreased years of disability


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Issues

IOL implantation andIOL power calculation

Capsule managementand Anterior Vitreousface

PostoperativeFollow-up


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Challenging Cases

Traumatic Cataracts

Capsular plaques

Pre-existing Capsulardefects

Anterior Lenticonus


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Traumatic Cataract

Blunt or penetratingtrauma

Young boyspredisposed tosports related, homeinjuries or work

related (innocentbystanders)


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Traumatic Cataract


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Traumatic Cataract


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Traumatic Cataracts

Small, localized, visually insignificantcataracts observe

Visually significant cataracts remove at about 4-6 wks followingprimary repair

Thorough evaluation for associated

injuries and their surgical M/m specially the capsular bag

Radiological Studies for RIOFB


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Capsule Plaques


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Posterior Capsular Plaques

More common with unilateral cataract

Thought to be caused by persistent

fetal vasculature even if no obvioushyaloid remnants seen

Variable incidence

Plaque peeling or posteriorcapsulorhexis/ vitrectorhexis

IOL in the capsular fornices


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Anterior subcapsular plaque

Incidence of

11.5% More

common withwhitecataracts


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Pre-Existing PosteriorCapsular Defects

Preoperativediagnosisdifficult but

possible insome cases(fish-tail sign)

Convert intoposteriorrhexis


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Pediatric Toric IOL(Anterior lenticonus)

Often associatedwith AlportsSyndrome

Marked thinningof central antcapsule

Ant capsule maybe fragile orextremely elastic


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Pediatric SupplementaryPseudophakic (Sulcoflex) IOL


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Preservative Free IntracameralTriamcinolone

Inject 4mg/0.1ml atthe end of surgery

Stains any vitreous

strands Provides postoperative

anti-inflammatoryaction

Useful as an adjunct topostoperative topicalsteroid eyedrops


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Controversies

IOL Implantation in Infants

Simultaneous Bilateral PediatricCataract Surgery


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Further Reading


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Audience Participation:Quick Poll

How many participants are doing pediatriccataract surgery

Would you implant an IOL in less than 1

year child with bilateral VS cataract?

How would you calculate IOL power?

Till what age post. capsulectomy and ant.

Vitrectomy is preferred?

Are you using intracameral triamcinolone inPCS?


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Pediatric Cataract Surgeryin Challenging Situations

Dr. Vidushi Sharma

MD (AIIMS, N.DELHI), FRCS (UK)

Dr Suresh K PandeyMS (PGIMER), ASF (USA)

SuVi Eye Institute & Lasik Laser Centre,Kota, RAJ., INDIA

Email- [email protected]: www.suvieye.com

Phone+ 91 9351412449NO FINANCIAL INTEREST
mailto:[email protected]://www.suvieye.com/http://www.suvieye.com/mailto:[email protected]


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Dr. Vidushi, MD, FRCS

www.suvieye.comEmail:suvieye@gmail com

Thank YouThank You

Image by: Austin Treasure Jansen
http://www.suvieye.com/http://www.suvieye.com/

pediatric cataract and iol surgery: current practices and controversies dr vidushi sharma & dr...

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