PAEDIATRIC CATARACT

 Irina Trifanenkova MD 

Femtosecond laser-assisted anterior and posterior capsulotomies are safe and effective techniques that can greatly enhance the quality of congenital cataract surgery in children, Irina Trifanenkova MD told delegates attending the 3rd World Congress of Paediatric Ophthalmology and Strabismus in Barcelona, Spain.

“There are a lot of advantages to using a femtosecond laser to create capsulotomies in paediatric cases. There is a decrease in surgery time, greater control of the surgical steps, reduction of intraocular lens manipulation and a reduction of intraoperative and postoperative complications with the creation of precise, perfectly-centred and round anterior and posterior capsulotomies,” she said.

Dr Trifanenkova, S Fyodorov Eye Microsurgery, Federal State Institution, Kaluga, Russian Federation, noted that congenital cataract remains one of the most common causes of childhood blindness worldwide and early surgical intervention is essential to prevent visual loss.

She reported a case series of femtosecond laser-assisted capsulotomies performed in 12 eyes of eight children aged from three months to seven years with congenital cataract. Anterior capsulotomy only was performed in eight eyes of four patients: two with swelling cataract, one with nuclear cataract and one with anterior capsule fibrosis. The remaining four patients received both anterior and posterior capsulotomies because of posterior capsule fibrosis, she explained.

FLUID-FILLED INTERFACE

Dr Trifanenkova said that the Femto LDV Z8 laser (Ziemer) offers a fluid-filled interface which allows the surgeon to easily dock the laser to the eye for anterior capsulotomy. Using very low energy of less than 1.0mj a gentle resection is possible in order to minimise risks and side effects in creating a capsulotomy of 2.5-4.5mm in diameter. She noted that surgeons should be aware that anterior capsulotomy size has a tendency to increase after laser treatment due to the high elasticity of the capsule in young patients, so this needs to be factored into the
surgical planning.

The integrated 3D optical coherence tomography system also allows easy visualisation of the posterior capsule in creating well-centred central posterior capsulotomies of 2.5-3.5mm in diameter. All of the surgeries in this series were performed without any complications and the anterior and the posterior capsule disks were removed by aspiration without any capsular tears. All the patients had postoperative period without complications and obtained excellent visual acuity at the end of the follow-up,
she said.

Summing up, Dr Trifanenkova said that the femtosecond laser provided a safe and effective means of creating anterior and posterior capsulotomies of perfect diameter and circularity in these challenging paediatric patients.

Irina Trifanenkova: nauka@eye-kaluga.com