Eyeworld

42 | EYEWORLD | JANUARY/FEBRUARY 2020 ATARACT C by Maxine Lipner Senior Contributing Writer Contact Wilson: wilsonme@musc.edu triamcinolone to make sure a vitreous wick is not present. Reopacification of the posterior capsule in children with trauma is also common in cases involving a primary posterior capsulorhexis, Dr. Wilson said. "I think that if we know it's a higher risk group from this series, we can try to remove all the OVD, pretreat if we think there is going to be a pressure rise, look more care- fully for retained vitreous, and use plenty of anti-inflammatory medication," he said. Also, carefully watching patients postoperatively can U nplanned returns to the operat- ing room within 90 days of initial cataract surgery in children occur at a rate of 3.3%, as determined by a study's 1 results, according to M. Edward Wilson, MD. Investigators of this study thought it was important to understand how often surgeons unexpectedly returned to the OR with patients in order to counsel parents, Dr. Wilson said. "We also wanted to see if any of these returns to the OR were preventable," he explained, adding that the chance of reoper- ation was something that was missing from the literature for the most part. The retrospective review included chil- dren who had undergone cataract surgery or a secondary IOL procedure by one surgeon for whom investigators had charts. This amounted to 1,392 eyes of 989 patients. By the numbers Investigators found 48 unplanned reoperations in the review, involving 46 eyes of 43 patients. When reoperations occurred, it was almost always in the first year of life or involved a traumatic cataract, Dr. Wilson reported. Chil- dren with trauma had a 2.5% greater chance of reoperation, while those who underwent cata- ract surgery in the first year of life were three times more likely to need reoperation. "If [the patient] didn't have surgery in the first year and didn't have a trauma as the reason they needed the surgery, then we could tell parents that in all other settings the unplanned reoperation rate was 1.1%," Dr. Wilson said. The more complicated the trauma and the more the iris manipulation, the more likely the patient might have to go back to the OR. "That's not necessarily a bad thing; it's just something to prepare the family for ahead of time," Dr. Wilson said. Also, to help reduce the reoperation rate, Dr. Wilson stressed the need to pay attention to the possibility of an intraoc- ular pressure spike. Care to completely remove any high viscosity ophthalmic viscosurgical device (OVD) is important. In addition, returns to the OR can be reduced by using intracameral Unplanned returns to the OR for pediatric cataracts About the doctor M. Edward Wilson, MD Professor of ophthalmology and pediatrics Storm Eye Institute, Medical University of South Carolina Charleston, South Carolina Reference 1. Jackson CM, et al. Unplanned returns to the operating room within three months of pediatric cataract-related intraocular surgery: indications and risk factors. J AAPOS. 2019;23: 224.e1–224.e4. Relevant disclosures Wilson: None Visual axis opacification in an infant Source (all): M. Edward Wilson, MD Inflammatory membrane in a microphthalmic eye continued on page 44 RESEARCH HIGHLIGHT

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