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A combined (posterior and anterior) approach to achieve good anatomical and functional results in the surgery of paediatric cataract

Session Details

Session Title: Paediatric Cataract Surgery

Session Date/Time: Monday 07/10/2013 | 16:30-18:00

Paper Time: 17:00

Venue: Forum (Ground Floor)

First Author: : A.Villarrubia SPAIN

Co Author(s): :    J. Laborda   D. Torres   C. Ramos   A. Cano   P. Martķnez Villa  

Abstract Details

Purpose:

Cataract in children is one of the leading and potentially avoided causes of blindness. The special characteristic of the child eye (anterior capsule elasticity, low sclera rigidity and higher than usual vitreous pressure) make of this surgery a challenging one. We want to show in this paper our surgical technique combining an anterior and posterior approach and to show the arguments to obtain both, anatomical and functional good results

Setting:

Instituto de Oftalmologķa La Arruzafa de Córdoba (Spain)

Methods:

We have operated 13 eyes of 9 patients with a mean age of 25,45 ± 12,84 months (3 - 42) with the same surgical technique. The mean follow up has been 29,2 ± 16,41 months (8 - 51). The surgical technique has been performed in all patients as follow: 1)- we introduce the 25G trocars in the pars plana; 2)- a 2,2 mm incision in clear cornea it is made and trypan blue is introduced into de anterior chamber to achieve a 5,5 mm curvilinear continuous capsulorrexis (CCC); 3)- phacoaspiration of the lens material; 4)- if the posterior capsule has not been broken, we implant an hydrophobic acrylic c-loop one piece IOL inside the bag and after this, we proceed to an small an central pars plana vitrectomy making a posterior capsulorrexis with the vitreotome in this moment (anterior-posterior approach); 5)- if the posterior capsule has been broken during the phacoaspiration, we proceed with the central pars plana vitrectomy trying to clean all the vitreous that usually it is seen at the pupillary level; then, we implant an hydrophobic acrylic three pieces IOL with the optical zone in the bag leaving the two haptics in sulcus (posterior-anterior approach)

Results:

In 3 of the 13 eyes, a posterior capsule break was seen during the phacoaspiration so, the anterior-posterior approach was performed in 76,9% of the eyes and the posterior-anterior one in 23,1%. We have performed two re-operations: one of them due to an intensive posterior inflammation that needed an IOL explantation (this eye were left aphakic) and the other one to re-open a posterior capsule fibrosis in a microphthalmic eye; both cases ended with a CDVA of 0,05. In a subset of 10 cases in which we could obtain enough collaboration of the child, the mean CDVA was 0,57 ± 0,36 (0,05 - 1) with 60% of the eyes better than 0,5. In this subset of patients, the mean spherical equivalent was +1,42 ± 2,15 (+6,5 – (-1,50)); the mean sphere was +1,50 ± 1,9 (0 – (+6,0)); and the mean cylinder was 1,3 ± 1,12 (0 – 3). No retinal complications has been found during the follow up period

Conclusions:

A combining approach for paediatric cataract surgery may improve the anatomical and functional results if we compare this technique with the classical anterior approach. This technique should be made by experienced surgeons and two specialists (anterior and posterior surgeon) are needed for a good final result

Financial Interest:

NONE