AVOIDING PCO

The bag-in-the-lens’ implantation method is safe and well tolerated in the paediatric population and addresses many of the risks of treating cataracts in this age group, according to Sorcha Ni Dhubhghaill MB, PhD, anterior segment fellow to Marie-José Tassignon MD, PhD, University of Antwerp, University Hospital Antwerp, Belgium. Dr Ni Dhubhghaill presented the results of a Belgian long-term follow-up study of bag-in-the-lens at the 2013 Irish College of Ophthalmologists Annual Meeting in Killarney, Co Kerry, Ireland in collaboration with Dr Jan Van Looveren, from University Hospital Antwerp. The treatment of cataracts in the paediatric population has long been known to pose more difficulties than in adult patients, she noted. For example, if the posterior capsule is left intact at the time of surgery, posterior capsule opacification (PCO) occurs in up to 80 per cent of cases. The bag-in-the-lens approach for inserting intraocular lenses addresses the high risk of visual axis opacification, Dr Ni Dhubhghaill explained. Avoiding PCO Under the study that she presented, the long-term results of all 31 paediatric cataract surgeries performed using the bag-in-the-lens method between July 1999 and September 2007 by a single surgeon (Prof Tassignon) were assessed.

Prof Tassignon developed the innovative bag-in-the-lens technique to avoid the development of PCO, the main complication of the traditional implantation technique for cataracts. 16 of the cases in the study were unilateral and 15 were bilateral, with a wide range of cataract types involved including nuclear fetal cataract and spherophakia. The age at the time of surgery ranged from two months to 14 years (mean of six years), while the follow-up periods ranged from 60 to 157 months (mean of 78 months). 15 children who underwent bilateral bag-in-the-lens surgery showed significant visual acuity improvements, from a pre- operative range of 0.0 to 0.4 (mean 0.2) to a postoperative range of 0.2 to 1.0 (mean Don’t Miss Book review, see page 37 EUROTIMES | Volume 18 | Issue 11 “ The bag-in-the-lens approach is a beneficial long-term treatment for the treatment of paediatric cataract Sorcha Ni Dhubhghaill MB PhD Highspeed Scheimpflug camera visualizes the future of diagnosis of 0.83). While one patient showed no improvement, there was no worsening of vision recorded in any patient. Overall, visual acuity of greater than 0.5 was achieved in the vast majority – 86.7 per cent – of these patients.

Meanwhile, all the 16 paediatric patients who underwent unilateral surgery showed improvement from a preoperative range of 0.0 to 0.4 (mean of 0.07) to a postoperative range of 0.0 to 0.7 (mean 0.27). These patients had poorer visual acuity outcomes than the bilateral cases and no unilateral patient achieved a postoperative visual acuity of 1.0. Dr Ni Dhubhghaill noted that unilateral cataracts have a high predilection for amblyopia and therefore still have a more guarded prognosis. She suggested that earlier surgical intervention and follow-up might yield more promising results in the future for these patients. Well tolerated Concluding her presentation, Dr Ni Dhubhghaill maintained that the bag-in-the-lens IOL implantation approach has been demonstrated to be safe and well tolerated in the paediatric population. “The bag-in-the-lens approach is a beneficial long-term treatment for the treatment of paediatric cataract," she told EuroTimes.