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Session Title: Paediatric Cataract Surgery
Session Date/Time: Monday 07/10/2013 | 16:30-18:00
Paper Time: 17:36
Venue: Forum (Ground Floor)
First Author: : W.Schmidt GERMANY
Co Author(s): : B. Lorenz
Cataract surgery in infants and children is complicated by a significant risk of after cataract even with primary posterior capsulotomy. One method to prevent this is implantation of a bag-in-the-lens IOL (BIL). This procedure involves clamping a BIL in a circular position between the anterior and posterior capsule. Thus, any potentially proliferating lens epithelial cells outside the optical zone should remain fixed in the capsule bag. We present the results of our first 33 BIL implantations in infants and children.
Consecutive case series of 11 children with unilateral and 12 children with bilateral cataract who were operated in a university hospital setting
A caliper ring was fixed on the anterior capsule by means of pressure with 1.4% hyaluronic acid injected into the anterior chamber. It was centered coaxially to an axis defined by the Purkinje 1 and 3 reflex images of the operating microscope. The anterior capsulorhexis was centered and its diameter determined by the caliper ring. Lens aspiration and cleaning of the posterior capsule was effected by bimanual technique using limbal paracenteses at the 6 and 12 o`clock positions. Before performing the posterior capsulorhexis the anterior vitreous surface was separated from the posterior capsule by injecting 1.2% hyaluronic acid in between through a small incision in the posterior capsule. The artificial lens was implanted by using a shooter followed by clamping both the anterior and posterior capsules together into the circular rim surrounding the optic part of the IOL.
So far, 33 BILs have been implanted (mean age 5 y 0 months, range 5 months-16 y). Eleven children had unilateral, 12 bilateral cataracts. BIL implantation was even possible in complicated cases like lentiglobus posterior, anterior segment coloboma, aniridia, uveitis, and calcification of the anterior capsule. In a premature infant with bilateral cataracts operated at age 5 months a BIL could be implanted only in one eye because of an oversized diameter of the anterior and posterior rhexis of approximately 1 mm in the other eye which therefore received a standard IOL. In one child with PFV BIL implantation was not possible. In the follow-up time (mean 0.97 years range 2 weeks- 2,6 years), some amount of secondary cataract occurred in one single eye due to imperfect matching of the anterior and posterior capsulorhexis, and was removed without complication. An age adapted target refraction was calculated with the SRK-T formula. The difference between target refraction and achieved refraction ranged from -2.7dpt to +4.4 dpt (mean +0.06 dpt). Visual acuity (Snellen equivalent) changed from a mean of 0.15 preoperatively (range 0.01 to 0.4) to a mean of 0.53 postoperatively (range 0.01 to 1.0).
BIL implantation in pediatric eyes is technically challenging but feasible even in difficult anatomical situations. In case of PFV with thickened peripheral posterior capsule the rim of the BIL can be too narrow to clamp both capsules, thus making its implantation impossible. When the sizes of the anterior and posterior capsulorhexis do not match perfectly, an after cataract may occur. No financial disclosures
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