Fifteen years of paediatric cataract surgery

Session Details

Session Title: Paediatric Cataract Surgery

Session Date/Time: Tuesday 13/09/2016 | 08:00-10:30

Paper Time: 09:02

Venue: Hall C1

First Author: : D.Silva PORTUGAL

Co Author(s): :    M. Mota   C. Pedrosa   P. Pego   S. Pinto   C. Vendrell   I. Prieto     

Abstract Details

Purpose:

Cataract represents a substantial cause of visual disability in the paediatric population worldwide. Surgical advances in the latest decade and a better understanding of visual rehabilitation strategies allowed not only better visual outcomes but also less intra-operative and post-operative complications. We present in video our surgical techniques throughout the years, highlighting our experience with micro-incision phacoaspiration in pediatric patients, a technique that has shown reduced surgical complications. Postoperative distance corrected visual acuity (DCVA), intra-ocular lens choice, additional surgical options, visual rehabilitation and complications were reviewed.

Setting:

Ophthalmology Department, Hospital Prof. Dr. Fernando Fonseca E.P.E., Amadora, Portugal.

Methods:

Retrospective analysis of 70 eyes of 49 children submitted to cataract surgery between 2000-2015 (congenital: n=56, acquired: n=14). We performed bimanual micro-incision phacoaspiration in 33 eyes. Bimanual anterior capsulorrhexis before main incision is performed to avoid instability of the anterior chamber. Primary posterior capsulotomy was always performed and anterior vitrectomy in patients under 3 years old. In unilateral cataracts primary implantation of acrylic hydrophobic 3-pieces posterior chamber IOL with optic capture was our preferred approach, performing secondary implantation mainly in congenital bilateral disease. Intracameral injection of preservative-free triamcinolone acetonide was important in reducing inflammatory reaction and improving vitreous visualization.

Results:

Average age at surgery was 4.80±5.23 years (from 8 weeks to 16 years) for congenital cataracts with mean DCVA post-surgery of 0.66±0.36. For acquired cataracts average surgery age was 10.54±3.45 years (from 4 years to 16 years) with mean DCVA post-surgery of 0.78±0.33. Intraoperative complications included ciliary sulcus implantation in 6 cases due to insufficient capsular support. Post-operative iris synechiae in 2 patients, 1 requiring re-intervention for synechiolysis. Visual axis obstruction occurred in 3 cases, despite primary posterior capsulotomy, requiring a second procedure. Visual rehabilitation was started after surgery, including amblyopia treatment with occlusions and pharmacological penalization and strabismus correction.

Conclusions:

A good knowledge of the specific characteristics of these patients is essential to overcome the challenging surgical difficulties inherent to pediatric cataracts and several strategies are needed to reduce intra and post-operative complications. Surgery is only the first step in this process of visual recuperation, therefore the faster the recovery time after surgery the quicker we begin visual rehabilitation with active treatment of amblyopia and strabismus whenever present. Acquired cataracts in our experience have shown better visual outcomes since they generally appeared after the critical period of visual development.

Financial Disclosure:

NONE