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Cataract Surgery and IOL Implantation in Children

Dr.P.Mishra

Page 2

Topics

Scleral Tunnel Surgery

A 6 mm wide frown scleral tunnel incision was given with a B.P. blade no.15, 2 mm posterior to corneoscleral junction, the two ends were around 4 mm behind limbus. The tunnel was dissected anteriorly to the vascular arcade with the help of Sharpedge angled tunnel blade no.4805 or by lamellar miniature blade no.6600.the anterior chamber was entered with a 3.2 mm Sharpedge angled keratome no.5540/5520,then the chamber was reformed with viscoelastic substance. A 5-6 mm diameter continuous curvilinear capsulorhexis was prepared. The capsule was initially opened with 26 G bent needle cystitome to create a small capsular flap. This flap was grasped with Masket capsulorhexis forceps and capsule was torn in a continuous curvilinear manner to complete the anterior capsulotomy. In few cases where rhexis was not possible anterior capsulotomy was done using 26 G bent needle. In no case a side port entry was made. Ringer’s lactate was used as the intraocular irrigating solution. To this solution was added 0.5 ml of 1:1000 intravenous adrenaline without preservative to maintain intraoperative mydriasis. The lens cortex and nucleus were aspirated using I/A canula or expressed by viscoexpulsion. All residual cortical matter near the equator of the lens or over the posterior capsule was meticulously removed. The capsule and anterior chamber were filled with viscoelastic substance. The inner entry was extended with the help of same keratome. The posterior chamber intraocular lens was implanted under direct visualization, the optic and both haptics were placed into the capsule. However, 3 cases it was implanted in the sulcus, where capsular bag was damaged. The IOL most commonly used were Appalens, Eye O Care and IMD lenses with a 6 mm optic and 12.5 to13mm overall diameter. The viscoelastic substance was removed with I/A. Subconjuctival injection cefazoline 50mg with dexamethasone 2 mg was given following which conjunctiva was closed with wet field diathermy.

In all the cases Prednisolone Acetate or Tobramycine- Dexamethasone eye drops and if required cyclopentolate 1% eye drops were applied postoperatively. The patients were examined daily during hospitalization for 3 days and were reviewed after 1 week, 2 weeks, 4 weeks, 3 months and then every 6 months. Postoperative refractions were performed at each visits and spectacles prescribed when the refraction was stable. If required, occlusion therapy of dominant eye for 75% to 90% of the child’s waking hours was instituted in patients younger than 9 yrs following one week of surgery.

Table 1 – Patient Demographics

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Type No of Patients No of Eyes Male:Female
Unilateral Congenital or Developmental 12 12 7:05
Bilateral Developmental 7 14 4:03
Traumatic 5 5 3:02
Total 24 30 14;10

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