Eyeworld

95 EW INTERNATIONAL February 2017 Contact information Ram: drjagatram@gmail.com Diffuse white cataract with PHPV Dr. Ram described a second scenario involving a 6-month-old infant with a diffuse white cataract. Ultraso- nography revealed the presence of a stalk extending between the optic disc and the lens, suggesting the diagnosis of combined PHPV. The axial length was 17 mm. After the removal of the cortical lens mate- rial, a densely vascularized mem- brane with a stalk was visible on retro illumination. The persistent fetal vessels on the membrane were cauterized with the help of endo- cautery to create an avascular plane. Using vertical microscissors, the membrane was cut 360 degrees, thus creating a posterior capsulotomy. The hyaloid vessels of the stalk were endocauterized and the remnants of the membrane taken out, followed by an anterior vitrectomy to release vitreous traction. Corresponding anterior and posterior capsulorhexis allowed the implantation of a single- piece IOL into the capsular bag. Dr. Ram explained that since PHPV was mostly unilateral, IOL placement was highly desirable to avoid ambly- opia arising from unilateral aphakia. Densely vascularized membrane with prominent ciliary processes and thin stalk A third scenario was that of a 2-year- old child presenting with a densely vascularized membrane with large prominent ciliary processes. Cutting the CCC is these cases can be chal- lenging because of the tension and size of the capsule. The persistent fetal vessels in the membrane were cauterized in a confluent pattern to create an avascular cleavage zone, and a posterior capsulotomy was created. Dr. Ram was careful at this point not to cut through the tense stalk of fetal vessels. After complet- ing the posterior capsulotomy, the fetal vessels in the stalk were cau- terized and the anterior vitrectomy completed to obtain a clear visual axis. An IOL was then implanted into the capsular bag. "Postoperatively, these eyes should be managed on a higher frequency of topical steroids, along with cycloplegics and antibiotics. Residual refractive error, if any, should be corrected and intensive amblyopia therapy should be initi- ated. Children with PHPV require a long-term follow-up to monitor for visual axis opacification, glaucoma, and posterior segment complica- tions," Dr. Ram said. EW Editors' note: Dr. Ram has no financial interests related to his comments.

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