From pseudo-accommodative IOLs to femtosecond laser: a whole life dedicated to the development of cataract surgery in children

Session Details

Session Title: Moderated Poster Session: Cataract
Session Date/Time: Friday 10/02/2017 | 13:00-14:00
Paper Time: 13:48
Venue: Poster Area


First Author: M. Fortunato ITALY
Co Author(s): A. Di Zazzo  A. Turturo  S. Crugliano           

Abstract Details

Purpose:

The analisys of the personal experience of Dr Michele Fortunato during 26 years of use of pseudo-accommodative IOLs(P-IOLs), and the evolution of cataract surgery till the Femtosecond laser–assisted tecnique (FLACS), in pediatric patients. Furthermore an evaluation of biometry in children.

Setting:

Ophthalmology Department of Hospital “Bambino Gesù” of Rome, Italy ; Centro Domus Palermo, Italy

Methods:

We made an accurate description of P-IOLs used during last 26 years by Dr Fortunato (Pharmacia IOL; Allergan Array IOL; Sifi Ioltech; Acri Tec Twin and Acri Lisa, Acri Twin 527/523; AMO Re Zoom; Alcon Restore; Rayner, AMO Tecnis; Soleko; Acrivia Reviol), followed by the analisys of the development of pediatric cataract surgery techniques and the biometry challenge in children, till the introduction of Femtosecond Laser–Assisted Cataract Surgery (FLACS) in pediatric patients.

Results:

Dr Fortunato has performed over 1200 P-IOL implants with customized approach, as primary or secondary implants, in the sulcus, bag, or scleral fixation, of all the previously described IOLs. Advantages are: Immediate pseudo-accommodative activity; Better functional recovery. Disadvantages are: IOL decentration; Difficulties in autorefractometry, Contrast sensitivity loss. These last have been limited using specific corrections to common practice. Biometry, preferably by immersion, has to be performed mostly under general anesthesia, because of young patient low compliance, avoiding iatrogenic error sources. FLACS opens new horizons, but, for now, difficulties in imaging and patient placement limit his use in pediatric cataract.

Conclusions:

The success in using P-IOLs led us to define the ideal one, which should be flexible and diffractive, with a +4 near addition and a wide range of dioptric powers. Furthermore, the surgical technique should be disease-customized. Biometry errors are due to corneal deformation induced by contact biometry or by speculum. Refractive target has to be hyperopic due to expected eye growth. FLACS simplifies and standardizes the critical steps of cataract surgery, reducing the total surgery duration, but its difficult execution in general anesthesia and the issues related to docking and imaging for pediatric patients, only allow a limited use.

Financial Disclosure:

None