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incision of 3 mm or less some surgeons are therapy for unilateral cataract after surgery
shifting to clear corneal incision with good should be instituted early as these children are at
results. Two paracentesis incisions are made in a higher risk of developing amblyopia. Children
the clear cornea. after cataract surgery need to undergo refraction
A Continuous curvilinear capsulotomy routinely due to the frequent refractive changes.
(CCC) is challenging as the anterior capsule is
more elastic. Rhexis should be aimed as small as Conclusion:
possible. The desirable size is 5.0 to 5.5 mm in Management of paediatric cataract is
diameter. It is preferable to use a cohesive challenging, if not treated early, may be
vicoelastic agent. Maximum removal of cortex associated with dismal results. However early
and lens epithelial cells from the equatorial surgery combined with appropriate refractive
region is essential. Cortical material is aspirated correction and aggressive amblyopic therapy
using two port irrigation-aspiration (IA). usually provide encouraging results. The role of
As Posterior capsular opacification parents is as important as the paediatric
(PCO) is the most frequent complication after a ophthalmologist for optimum visual outcome.
successful surgery in children, primary posterior
capsulotomy with anterior vitractomy needs to
be done [8,9].
References:
1. Jagat Ram, Crrent Surgical Techniques for Pediatric
An ideal PCCC should be around 3-4 mm Cataract Surgery, Ready Reckoner in
circular ring and should be performed under the Ophthalmology 2010, p 179-182.
age of 6 years. Most surgeons prefer doing 2 . GVS Murthy, N Jhon, SK Gupta, P Vashist, GV Rao;
anterior vitrectomy to decrease the PCO, stabilise Status of pediatric Eye care in India; Indian Journal
the IOL and vitreous prolapsed in the anterior of Ophthalmology 2008: Vol 56, Issue 6 ,pp 481-88
chamber. The vitrectomy may be performed 3. Rishikesh Mayee , Pediatric Cataract- Management
using limbal or pars plana route. Options, DOS Times- Vol. 15, No. 8, February 2010.
Capsular bag implantation is the best 4 . Ram J, Brar GS. Textbook of Pediatric Cataract
Surgery , Jaypee Brothers, New Delhi, 2006.
choice. Hydrophobic acrylic, foldable lens are
5. Dahan E. Intraocular Lens implantation in children.
preferred now a days [10,11]. Some surgeons Curr Opin Ophthalmol. 2000 Feb; 11(1): 51-5.
prefer optic capture, whereby haptics are placed 6. Chee KY, Lam GC. Management of congenital cataract
in the bag and optic is pushed through the PCCC. in children younger than 1 year using a 25-gauge
The principle behind the optic capture is to avoid vitractomy system. J Cataract Refract surg. 2009
the need for vitrectomy and better IOL Apr;35(4):720-4.
centration. 7. Bayramlar H, Colak A. Advantages of the sclera
All incisions should be closed with a incisions in pediatric cataract surgery. J Cataract
suture because of lower scleral rigidity with Refract Surg. 2005 Nov;31(11):2039.
8. Dholakia SA, Praveen MR, Vasavada AR, Nihalani B.
higher risk of fish mouthing of the incision.
Completion rate of primary posterior continuous
For secondary IOL in paediatric aphakia, curvilinear capsulorhexis and vitreous disturbance
the IOL is can be implanted in the sulcus, and during congenital cataract surgery. J AAPOS. 2006
very rarely into the capsular bag. PMMA lenses Aug;10(4):351-6.
are preferred over acrylic IOLs for lesser chances 9. Hardwig PW, Erie JC, Buettner H. Preventing
of decentration [12]. recurrent opacification of the visual pathway after
Post-Operative Management: pediatric cataract surgery. J AAPOS.2004
Pediatric eye tends to show more tissue De;8(6):560-5.
reaction and chances of fibrinous reactions are 10. Nihalani BR, Vasvada AR. Single-piece AcrySof
intraocular lens implantation in children with
significantly high. Hence post-operative
congenital and developmental cataract. J Cataract
management include frequent instillation of high Refract Surg. 2006 Sep; 32(9):1527-34.
potent topical steroid like prednisolone acetate 11. Aasuri MK, Fernandes M, Pathan PP. Comparison of
and a cycloplegic agent. If required systemic acrylic and polymethyl methacrylate lenes in a
steroid have to be administered. pediatric population. Indian J Ophthalmol. 2006
Visual Rehabilitation: Jun; 54(2): 105-9.
Visual rehabilitation is as important as 12. Trivedi RH, Wilson ME Jr, Facciani J. Secondary
surgery itself. Amblyopic therapy should be intraocular lens implantation for pediatric
instituted meticulously. Children <2 years aphakia. J AAPOS. 2005 Aug;9(4): 346-52.
retinoscopy is done on the table after surgery -------------------------------------------------
and prescribe glass immediately. Occlusion
International Journal of Current Medical And Applied Sciences [IJCMAAS] volume 5, Issue 1.