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Management of IOLs in Pediatric Cataracts: When, How, Where, and
Which type of IOL.Jos A. Cristbal, Mara A. del Buey, Len Remn,
Francisco J. Ascaso.Department of Ophthalmology Lozano Blesa
Clinical University Hospital, Zaragoza, SPAINNo author has a
financial or proprietary interest in any material or method
mentioned.
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2To describe the different possibilities of treatment in
pediatric cataract with IOL implantation; analyzing the type of
IOL, the position of the haptics (sulcus or in the bag), the
position of the optic (in the bag or into the vitreous), the
posterior capsulorrhexis and anterior vitrectomy (depending on the
age and cooperation of the patient) and the use of multifocal IOLs
in special cases. Purpose
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3 CARACTERISTICS OF PEDIATRIC CATARACT SURGERYSmall eye, elastic
capsule, quick capsular opacification, difficulty in IOL power
calculation, postoperative treatment of amblyopia very hard.WE
RECOMMEND EARLY SURGERYTechnique: Lens phacoaspirationIn case of
great risk of deep amblyopia: congenital, central, dense, wide,
total, (with significant visual impairment).When to perform
surgery?Cataract surgery in children needs special considerations
in the use of IOLs and also in lens power calculation. It is
necessary to do a very careful surgery, having always in mind the
necessity of transparency in the visual axis and a good state of
eyeball in case of the possibility of future surgery.
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4Causes of opacification:Epitelial cells proliferation and
migration in posterior capsule Inflamatory membranes Anterior
vitreous opacificationAnterior CapsulorrhexisMANEUVERS TO AVOID
POSTOPERATIVE OPACIFICATION OF VISUAL AXIS. They are necessary in
non-cooperative children (usually under five years of age), when
there is no possibility of doing a Nd YAG laser posterior
capsulotomy in the slit lamp.MANEUVERS
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5TREATMENT: BILATERAL CATARACT EXTRACTION WITHOUT IOLRemoval of
fibrosis over the lens surface, anterior capsulorrhexis,
manualaspiration of lens material, posterior capsulorrhexis and
central anterior mechanical vitrectomy.A six-month-old baby with
bilateral cataract, microphthalmos and iris abnormalities. Silicone
contact lenses correctionAphakic SpectaclesCONGENITAL PEDIATRIC
CATARACT ASSOCIATED WHITH OTHER ABNORMALITIES.
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6A two-year-old child with total monolateral pediatric cataract.
The Echography shows persistent fetal vessels. CONGENITAL PEDIATRIC
CATARACT ASSOCIATED WHITH OTHER ABNORMALITIES. TREATMENT: CATARACT
EXTRACTION WITH MONOFOCAL IOL IN SULCUS AND POSTERIOR OPTICAL
LUXATIONAnterior capsulorrhexis, phacoaspiration of lens,
incomplete posterior capsulorrexis preserving the central vessel,
anterior vitrectomy, IOL in sulcus with the optic into the vitreous
displacing the vessel.
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DESIGN MONOFOCAL 3 PIECES IOL WITH HAPTICS IN SULCUS AND THE
OPTIC IN THE BAG OR LUXATED INTO THE VITREUSPOWERUNDERCORRECTION
20%7CHILDREN UNDER 2 YEARS OF AGEDESIGN MONOFOCAL 3 PIECES IOL IN
THE BAG OR WITH THE OPTIC LUXATED INTO THE VITREUS POWER EMMETROPIA
UNDERCORRECTION 10%WE RECOMMEND INTRAOCULAR LENS IMPLANTATION
ALWAYS IF POSSIBLECHILDREN BETWEEN 2 AND 4 YEARS OF AGELuxation of
the optic
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Since 2004, we have had a good experience in children with
monocular cataract (developmental, evolutive, traumatic) and
emmetropic contralateral eye. It is our choice to improve
binocularity and even stereopsis for distance and near vision.8
MULTIFOCAL DIFRACTIVE IOLS IN CHILDRENGood visual prognosisIdeal
capsular supportPosibility of good biometric calculationEnough
ocular developmentWHEN?MF IOLSurgery in a polar evolutive central
cataract. Anterior and posterior capsulorrhexis removing polar
opacification. Multifocal IOL in the capsular bag. Clear visual
axis in a child two years after surgery.
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9
In our experience, the best option to manage with pediatric
cataract is to implant an IOL after cataract extraction, unless the
presence of associated ocular abnormalities make it inadvisable .
Visual recovery will be faster than in pediatric aphakic eyes and
less "hard". Controversy still persists about the appropriate power
of the IOL and how to calculate it. ConclusionJos A. Cristbal MD,
PhD, FEBO. Clinical University Hospital Zaragoza, SPAIN
