Eyeworld

EW CATARACT 38 March 2019 Presentation spotlight by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer explained that the younger the eye, the greater the threat of visual obscuration. In a different study that Dr. Vasavada performed involving VAO after cataract surgery and hydrophobic IOL implantation in pediatric patients less than 1 year of age, nearly 25% of the operated eyes of infants required a second- ary surgical procedure for VOA. He found the rate was higher in female infants' eyes but did not differ be- tween IOLs. The data indicated that significant VAO noted in 32 eyes (45%) and none in 39 eyes (55%). The patients underwent second- ary membranectomy and Nd:YAG laser capsulotomy was done in 31 eyes (43.6%), while in 40 eyes (56.4%) it was not required. The mean duration from surgery to the secondary procedure was 22.31 ± 11.26 months; the median duration to the secondary procedure was 21 months. Six eyes (8.45%) needing a secondary procedure were younger than 1 year of age. Dr. Vasavada interventions, and retinal detach- ment. Visual outcome was noted by the best spectacle corrected visual acuity. The mean preoperative axial length was 21.1 ± 2.75 mm in the study eyes, the mean IOP was 13 ± 2.41 mm Hg, and the horizontal corneal diameter was 11.1 ± 0.94 mm, which were all within the normal range, he said. Additional patient information included: • Mean patient age at surgery: 33 ± 30 months (range 2–111 months or 12 years) • Mean follow-up duration: 126.7 ± 19.7 months (roughly 10 years) • Median follow-up duration: 121 months (10 years) • Children younger than 1 year of age at time of surgery: 32 eyes of 17 patients (45%) • Children 6 months old or younger when operated: 20 eyes of 10 • Patients with unilateral cataract: 3 • Patients with bilateral cataract: 34 • Female patients: 14 • Male patients: 23 Cataracts among the study pop- ulation varied morphologically. • Lamellar cataracts: 40% • Mixed morphology: 31% • Membranous cataracts: 16% • White cataracts: 12% • Posterior polar/posterior subcap- sular cataracts: 1% Dr. Vasavada reported that almost 50% of the eyes had squint preoperatively, observed in 34 eyes out of the total of 71 eyes and absent in 37 eyes. Nystagmus was present in 16 eyes and absent in 55 eyes. Intra- and postop complications None of the eyes demonstrated major intraoperative complications. Posterior capsule plaque was noted in 3 eyes (4.2%) and preexisting pos- terior capsule defect was seen in 8 (11.2%). Vitrectomy was performed in 42 of the eyes (59.1%). The cri- teria for vitrectomy was patient age under 3 years, inadvertent vitreous face disruption, or the inability to perform laser capsulotomy in a child more than 3 years of age. Despite vitrectomy, visual axis obscuration was seen, with Follow-up data reveal single piece in-the-bag IOL implantation in pediatric patients is safe, effective S tudy outcomes on pedi- atric patients with im- planted single piece IOLs are now available to help physicians understand the risks and benefits of IOL implanta- tion in very young eyes. According to the 10-year out- comes, in-the-bag implantation of a single piece hydrophobic acrylic AcrySof IOL (Alcon, Fort Worth, Texas) is safe and effective in the long term, with good uveal and capsular biocompatibility. Shail Vasavada, DO, Ahmedabad, India, one of the study's co-investigators who presented the work at the 36th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS), reported that visual axis opacification (VAO) in pediatric patients will usually become evident within 3 years of surgery and that glaucoma was more likely to devel- op in patients operated at a younger age, especially under the age of 1. Long-term pediatric study The study evaluated the long-term outcomes of in-the-bag single piece hydrophobic acrylic IOL implan- tation following congenital and developmental cataract surgery. The retrospective, observational case series of 71 eyes (37 patients) un- dergoing cataract surgery included cases with at least 10 years of post- operative follow up. It excluded eyes with microcornea, microphthalmos, and any co-existing ocular morbidi- ty. The single surgeon implemented a standardized surgical technique involving manual anterior capsulor- hexis, bimanual irrigation/aspira- tion, manual posterior capsulorhex- is, limbal anterior vitrectomy, and the implantation of the in-the-bag single piece AcrySof IOL SA60AT. Dr. Vasavada assessed outcomes over 10 years. At the final follow-up visit, postoperative complications were divided into: glaucoma, visual axis obscuration, secondary surgical Pediatric IOLs: 10 years on The study evaluated the long-term outcomes of in-the-bag single piece hydrophobic acrylic IOL implantation following congenital and developmental cataract surgery. Source: Shail Vasavada, DO

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