Eyeworld

EW CATARACT 36 December 2016 Presentation spotlight by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer indications to surgery included eyes with inflammation, ocular trauma, aniridia, chorioretinal coloboma, and vitreoretinal disease. "Cataract surgery in this patient group helps to prevent amblyopia and strabismus while allowing a full visual development of the visual system. But the reduced operative working field in microphthalmic eyes increases the risk of com- plications. We have adapted our technique for cataract surgery for microphthalmia," he said. The surgery consisted of lens aspiration and IOL implantation, using a 4 mm capsulorhexis. Dr. Borroni explained that posterior Specialists look at today's and tomorrow's surgical solutions M icrophthalmia is a developmental eye disorder in which the axial length of one or both eyes is shorter than normal, due to genetic abnormalities. Raised intraocular pressure, cataract, and poor vision are frequently observed in patients with microphthalmia, as well as a number of other ocular and non-oc- ular abnormalities. Classical treat- ment involves spectacle correction with patching of the strong eye to strengthen vision in the affected eye. However, in the presence of cat- aract, surgery is crucial to enable a child's visual development. Cataract surgery in microphthalmic eyes is complex and requires a skilled hand. A research group in Riga, Latvia, shared its experience with the sur- gical management of cataract with subsequent IOL implantation and discussed the future of microphthal- mic gene engineering at the 2016 European Society of Cataract and Refractive Surgeons (ESCRS) annual meeting. New study with good results "Our small case study showed that primary IOL implantation in cases of congenital cataract surgery for microphthalmic eyes significantly improved best corrected visual acu- ity (BCVA) with a very low rate of complication," said Davide Borroni, MD, ophthalmology resident, Riga Stradins University, Riga, Latvia. "It demonstrated that axial length was a significant risk factor for postop complications, such as increased IOP and secondary axial opacification." In the study, 20 microphthalmic eyes from 14 children (mean age 23.9±1.7 months) with congenital cataract underwent cataract surgery and IOL implantation. Six patients had bilateral cataract and eight had unilateral cataract. All patients were under 3 years of age. Microphthalmia is defined as a disease when the axial length of an eye is below 20 mm. The mean axial length of the eye in the study was 18.6±0.7 mm. Primary outcome mea- sures were IOP, BCVA, and intra- and postoperative complications. Contra- Microphthalmia with congenital cataract Evaluation of microphthalmic eye with cataract and retinal anomalies Source: Davide Borroni, MD capsulorhexis was safe for young pa- tients, adding that anterior vitrecto- my was not performed routinely for microphthalmic cataract cases in his eye clinic. He said the high elasticity of the capsular sac in this age group allowed for obtaining enough space to accommodate the IOL, permitting the 4 mm capsulorhexis to easily stretch up to 6 mm. The outcomes showed that the mean postoperative IOP value was 10.8±2.7 mm Hg at the time of the final follow-up, compared to the mean preoperative IOP value of 9.3±1.2 mm Hg. Dr. Borroni observed no intraoperative compli- cations and very few postoperative complications. Secondary visual axis opacification developed in only one eye—the shortest eye in the study— measuring 17.9 mm. "We see more complications in smaller eyes. The two most relevant complications after this type of cataract surgery are increased IOP and opacification of the visual axis. In terms of IOP, the pressure can appear stable, but still continue rising 5, 7, even 10 years after surgery," he said. Only one case of opacification was observed and it was in the eye with the smallest axial length. Opacification could be promoted by a narrow working field during surgery.

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