Eyeworld

EW INTERNATIONAL 76 November 2016 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer Two-step surgery Dr. Yugay noted that surgery in children presented very particular challenges. "Phaco in young pa- tients can be difficult with regard to capsulorhexis and phaco aspiration, but the main problem lies with pos- terior capsule opacification and the opacification of the anterior vitre- ous. We observed secondary cataract in 100% of our surgeries." Dr. Yugay and her team in Moscow performed lens aspiration, IOL implantation, and posterior capsulorhexis with anterior vitrecto- my all in one surgery, under general anesthesia. PCO and anterior vit- reous opacification, however, were observed within 3 to 4 months post- operatively. "We tried to perform posterior capsulorhexis along with IOL implantation, but saw opaci- fication in the early postoperative period. We now perform a two-step surgery. The first surgery consists of aspiration and IOL implanta- tion. Then, 3 to 6 months later, we perform a pars plana vitrectomy and posterior capsulorhexis. Sometimes we combine phaco and IOL implan- tation in one eye with vitrectomy and posterior capsulorhexis in the other eye. This gave us good func- tional results." In cases of bilateral cataract, surgery on the second eye is carried out 3 to 7 days after the first surgery Dr. Yugay presented a case series of 13 children including six girls and seven boys between the ages of 4 and 12 years with corneal astigma- tism ranging from 2 to 3.5 D. Eleven children had congenital cataract and two had traumatic cataract after penetrating corneal wounds. The purpose of the study was to evaluate the safety and efficacy of toric IOL implantation in cataract surgery in children. All of the children underwent phacoemulsification and implan- tation of the AcrySof IQ Toric IOL (Alcon, Fort Worth, Texas) of 24 to 27 D, using models SN60T4 to SN60T8 for cylinder. Visual acui- ty before surgery was 0.02 to 0.3. Patients with congenital cataract had with-the-rule astigmatism, and the traumatic patients had irregular, against-the-rule astigmatism. The surgeries were unevent- ful. The uncorrected visual acuity ranged from 0.4 to 0.8 on the first postoperative day, improving to 0.6 to 0.9 at 1 month after surgery. "Improvement in visual acuity was observed both in those children who wore glasses for astigmatism prior to surgery and in those who did not require spectacle correction," she explained. Uncorrected astigmatism in children with congenital cataract can lead to amblyopia and needs to be addressed early on. Pediatric astigmatism Astigmatism correction is an im- portant task in the treatment of children with congenital cataract, according to Russian investigator Maria Yugay, MD, M.F. Vladimirsky Moscow Regional Research and Clin- ical Institute, Moscow, Russia, and needs to be addressed. "We think the only good option in pediatric cases is to implant toric IOLs for the correction of 2 D or more. First of all, we need to avoid the develop- ment of amblyopia in children by eliminating the need to wear glasses with cylindrical correction. There are three ways to do this at the time of cataract surgery: placing a main incision on the steep axis of astig- matism, placing corneal relaxing incisions, and implanting toric IOLs. The first two options allow us to correct only 1 to 2 D of astigmatism with a further drawback being unsta- ble results, particularly in children," Dr. Yugay said in a presentation she gave on the study at the XXXIV Congress of the ESCRS in Copenha- gen. She co-authored the study with colleagues Alla Ryabtseva, MD, and Irina Tarabanko, MD. Russian surgeons present congenital cataract surgical case series I mplanting toric IOLs for astigmatism correction in cases of pediatric cataract is a safe and effective way to correct the astigmatism that so often accompanies congenital cataract, according to outcomes of a study out of Moscow. The high frequen- cy of astigmatism in children born with congenital cataract necessitates prompt action on the part of the surgeon. High incidence of astigmatism The incidence of astigmatism in children with congenital cataract is high, as shown by a Japanese study by Watanabe et al. that retrospectively reviewed 99 eyes of 62 patients that underwent congen- ital cataract surgery between 2000 and 2012. 1 The study maintained that 65.7% of children with con- genital cataract had concomitant astigmatism in excess of 2 D. Of these, 83.8% had with-the-rule astigmatism, 5.1% had against-the- rule astigmatism, and 11.1% had astigmatism with an oblique axis. In patients with unilateral cataract, cataract eyes had higher corneal astigmatism than normal eyes. Toric IOLs in pediatric cases Posterior capsule opacification following pediatric toric IOL implantation Presentation spotlight Implantation of toric IOL Source: Maria Yugay, MD

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