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Pediatric Cataract Surgery, Novel Techniques for Unique Surgeries
Ken K Nischal MD, FAAP, FRCOphthProfessor , School of Medicine, UPMC
Chief , Division of Pediatric Ophthalmology and StrabismusVice Chair , Dept of Ophthalmology , UPMC
Assistant Medical Director , International , UPMC
Disclosures
• Ophtec Sponsored clinical trial participant• Honorarium for Carl Zeiss Meditech Inc
• Executive Director of Charity – World Society of Paediatric Ophthalmology and
Strabismus
Banded Technique
Pre-Operatively
• Decision to Place IOL• Posterior Optic Capture
Biometry
• I always do both eyes• A scan • LEFT EYE
– ACD 3.1mm– AL 21.3mm
• RIGHT EYE– ACD 3.9mm– AL machine would read eye was aphakic,?? then not
AL 21.4mm
Posterior Lenticonus
What would you do now?
• Leave aphakic• Leave in sulcus• Put in bag
I avoid putting in sulcus in younger children
• Effect on iris root and angle– Ozdal PC, Mansour M, Deschenes J. Ultrasound biomicroscopy of
pseudophakic eyes with chronic postoperative inflammation. J Cataract Refract Surg 2003;29:1185-91.
– Hato no N, Haruno L, Nishimoto H et al. Histopathological study of anterior segments of the eye with the intraocular lens in the posterior chamber. Ophthalmologica 1994:208:293-303.
• Effect on ocular growth– Griener ED, Dahan E, Lambert SR. Effect of age at time of cataract
surgery on subsequent axial length growth in infant eyes. J Cataract Refract Surg 1999;25:1209-13.
Keratolenticular Adhesion
Factors influencing decision to perform PKP in Congenital Keratolenticular
Adhesion
• Social circumstances• Follow up• Aim for each child
20/100
3 month old
Previous LiteratureSawada M, Sato M, Hikoya A, et al.
A case of aniridia with unilateral Peters anomaly. J AAPOS167 2011;15:104-6.
• In the only similar case reported by Sawada et al, a worsening in the corneal opacity due to peeling of the adhesion, was noted after lensectomy.
• The lens was adherent to cornea with no clear demarcation between the Descemet’s membrane and anterior capsule
Technique
c/o Kira Lathrop
Conclusion
• Under certain circumstances• Cataract Extraction with Iridectomy may provide
visual rehabilitation instead of Corneal Transplantation with lensectomy