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