Lens Sparing Cataract Surgery

To show that in contrast to age related cataracts , operating on catracts in uveitis cases , many variations are to be expected

In the case presented what looked as definite  white catract in a child with chronic uveitis, the opacities proved to be layers of opaque membranes that could be dissected of the crystalline lens leaving an intact and clear lens.

Meticulous and patient dissection was needed to keep lens capsule uninjured 

Childvision markedly improved and he maintained his strong accomodation.Membranes did not recur till his last 6 months follow up

5 year old child with  bilateral white cataracts , total posterior synechia and Band Shaped Keratopathies (BSK) , his vision was very poor.  

Decision was to combine phototherapeutic keratotomy (PTK)  to clear the cornea then to proceed to lensectomy wtht intraocular lens implants

Opacities on the crystalline lenses were found to be  removable without sacrificing the natural lenses after tedious and careful dissection

PTK was done first simultaneously on both eyes in lasik suite  , it cleared the central part of the cornea in each eye , then child was transferred to OR for cataract surgry on left eye first 

During dissection of posterior synechia , opaque membranes started to show an edge , on holding this edge i could slowly detach opaque membranes from the natural lens . this was followed till natural lens found clear with intact anterior capsule. natural lens was spared and decision was made not to remove it.

Although child father was first disappointed that his son did not receive the planned intraocular lens , he could realize after explanations anf after realizing how much his child vision  improved, that it was much better for his child 

Technique was repeated few days later on the right eye hoping to repeat same technique but was much more challenging, opacities felt inseparable from anterior capsule , just before deciding on sacrificing the natural lens , opaque membranes could be finaaly separated after  very tedious efforts , I was glad not to disappoint the father yet again that we could not maintain the natural lens that he now knew was better for his child

same technique could be repeated on another child 2 years later , with equl good results.

In managing cataracts in uveitis cases , multiple variatons are to be expected

Before deciding to remove the natural lens it is good to see if possible to clear the opaque membranes without sacrificing the crystalline lens. it does happen.