The main objective of this study was to find out
It is a fact that the conventional aphakic spectacles are useful in optical rehabilitation after bilateral congenital or developmental cataract surgery but not satisfactory for rehabilitation after unilateral or traumatic cataracts because of the problem of aniseikonia. Therefore it is a greatest barrier to good visual out come and cosmetically unappealing also. Unilateral or bilateral contact lens rehabilitation has the advantage of providing accurate and changeable optical correction. How ever, contact lens use in children requires significant co operation among parents, child and practioner. During last few years, the recent development of capsulorhexis and placement IOL in the bag has led to renewed interest for IOL implantation in children, but controversy still surrounds the question of how much hyperopia children should remain. Some ophthalmologists believe the child should made emmetropic or even myopic without concern for later myopic, they advocate curing the amblyopia and handling the myopia later. Some argue the opposite view points. What ever the fact, it is not always easy to calculate the IOL power in children. In that case one could implant standard +20.50D lenses.
The visual outcome of childhood cataract is dependent on many factors such as type of cataract, age of onset, age at surgery, duration of opacity and compliance with optical rehabilitation and occlusion. This trial was designed to determine the best and most suitable surgical treatment for childhood cataract at present time. Overall in 90% of eyes the visual acuity was achieved 6/60 or better. Although there is no much variation in the final visual out come in three different groups the complications are less encountered with scleral tunnel surgeries. In no time eye collapses, anterior chamber becomes flat or there is iris prolapse during this procedure. It is much easier, surgeon is comfortable through out the procedure. How ever, tunnel dissection is little difficult in children, as the sclera is little thin. One should avoid muscle relaxants during general anaesthesia and could master the technique in no time. Similarly rhexis is more difficult in children as it is not easy to tear anterior capsule, with experience it is not a problem at all. The key to it’s success is to start the rhexis more centrally ie.the capsule should be opened with a 26 G bent needle, the starting position should be more central to create a small capsular flap, then the flap is grasped with Masket capsulorhexis forceps and the capsule is torn in a continuous curvilinear manner avoiding radial extension.
Retinal detachment is well recognized and usually a late complication of cataract surgery in children. In this series there were two retinal detachments encountered, one in lensectomy group and other which was pre existing in the scleral tunnel group, which was due to high myopia. Conclusion. Management of childhood cataract poses many challenges to the ophthalmologists in the developing countries. Over the years there has constantly been search for a new technique, that more effectively manage paediatric cataract. Prior to CCC most IOLs were almost left partly or fully supported by ciliary sulcus. Since uveal tissue in a child is highly reactive, placement of IOL in the bag has been viewed, as highly desirable by most of the paediatric cataract surgeons. We recommend scleral tunnel cataract surgery, that is self sealing, sutureless and phacoless is the surgery of choice at present, for paediatric cataracts because of following reasons.
No doubt the paediatric surgeons now stand at the threshold of a new era filled with excitement, which greeted modern cataract surgeons few years back as they entered to sutureless cataract surgery with IOL implantation. Should we say now, good bye to ECCE and Lensectomy?
For correspondence write to
Professor of Ophthalmology,
R.M.M.CH.,Annamalai University-608002 India.
e-mail: [email protected]
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