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(يرفع ا الذين امنوا منكم والذين
أوتوا العلم درجات وا بما
تعملون خبير) )11(المجادلة:
ADVANCES IN CONGENITAL CATARACT
SURGERY
By
Hani Gheith Mousa
Anatomy of the lens
The pars plana area is smaller in children than in adults
Growing of child eyes cause changes in ocular axis, this causes change of the refractive state from hyperopic to myopic
At birth the axis is 16.5mm, and in adulthood it reaches 23.5mm
At birth, the normal human infant corneal power averages 51D, lens power averages 34D, the corneal diameter averages ten mm. and the axial length 16.5 mm. This very short eye with a rather round lens and small steep cornea rapidly changes shape and size over the first two years of life.
Cataract
• Is a lens opacity that prevents the path of light rays from entering the eye
PEDIATRIC CATARACT CAN BE CLASSIFIED
ACCORDING TO
PEDIATRIC CATARACT CAN BE CLASSIFIED
ACCORDING TO
AGE OF ONSETAGE OF ONSET MORPHOLOGYMORPHOLOGY CAUSE CAUSE
According to age of onset
1. Congenital
2. Developmental
According to age of onset
1. Congenital
2. Developmental
According to
morphology
Zonular cataract
Polar cataract
Total cataract
Blue dot cataract
Coralliform cataract
Membranous cataract
Zonular cataract
Zonular cataract
• Nuclear cataract • Lamellar cataract
• Sutural cataract • Subcapsular cataract
Zonular cataract
• Nuclear cataract • Lamellar cataract • Sutural cataract • Subcapsular cataract
Zonular cataract
• Nuclear cataract • Lamellar cataract • Sutural cataract • Subcapsular cataract
Zonular cataract
• Nuclear cataract • Lamellar cataract • Sutural cataract • Subcapsular cataract
Polar cataract
Polar cataract
• Anterior polar cataract
• Posterior polar cataract
Polar cataract
• Anterior polar cataract
• Posterior polar cataract
Total cataract
Blue dot cataract
Membranous cataract
Diagnosis of
Congenitalcataract
• Parents may notice that their young child shows lack of visual attention to the environment
• Another important symptom may be nystagmus of the searching or wandering type
• Also Photophobia may be a presenting symptom, mainly in lamellar or zonular type
• Cataract may become obvious to a parent or a pediatrician as a white reflex in the pupil (leukocoria)
•Pre-operative examination
Examination under operating microscope or slit lamp biomicroscope
• Examination under operating microscope or slit lamp biomicroscope
• Tonometry
• Tonometry (TONO-PEN)
• Tonometry ) schiotz )
• Posterior segment evaluation.
• Keratometry and biometry.
• Keratometry and biometry.
PERFERENTIAL LOOKING
e.g. Brightly colored toys
NB, the human face is an ideal target
VISUAL ACUITY ASSESSMENT IN PREVERBAL
Brightly colored toys
• Hundreds and thousands test
VERBAL CHILD
• At age two yearsHave sufficient language skills to
undertake picture taking test
• At age three years, will able to undertake the
matching of single letter Optotype
• At age four years, most children will be
able to perform a linear Snellen acuity test
• Es chart
Snellen acuity chart
• Cycloplegic refraction by retinoscopy, auto-refractor
• Cycloplegic refraction by retinoscopy, auto-refractor
• Strabismus evaluation
COVER UN-COVER TEST
• Operation.
• Incision
• Air injection into AC
• Injection of 0.1% trypan blue under the air bubble.
• Anterior capsulorrhexis
• Irrigation aspiration
• Irrigation aspiration
• Posterior capsule staining
• Posterior capsulorrhexis
• Posterior capsulorrhexis
• Posterior capsulorrhexis
• Anterior vitrectomy
• INTRAOCULAR LENS IMPLANTATION
• piggybacked IOL.
Ultrasound Biomicroscopy (UBM) Guided Secondary Implantation in Aphakic Children
complications of cataract
surgery
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration • Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
• Rupture of posterior capsule and vitreous loss.• Hyphaema.• Corneal oedema .• Difficult I0L centration• Iridocyclitis.• Intraocular Lens deposits.• Opacified posterior capsule.• Retropseudophakos membrane.• IOL malposition and dislocations• Secondary glaucoma.• Cystoid macular oedema.• Retinal detachment.• Endophthalmitis• Amblyopia • Strabismus.• Synechiae. • Capsular contraction
VISUAL REHABELITATION AFTER CATARACT SURGERY
• Spectacles.
• Contact Lenses. • Epikeratophakia. • Intracorneal rings. • Intraocular Lenses.• Refractive surgery.
• Spectacles.• Contact Lenses. • Epikeratophakia. • Intracorneal rings. • Intraocular Lenses.• Refractive surgery.
• Spectacles.• Contact Lenses. • Epikeratophakia. • Intracorneal rings. • Intraocular Lenses.• Refractive surgery.
• Spectacles.• Contact Lenses. • Epikeratophakia. • Intracorneal rings. • Intraocular Lenses.• Refractive surgery.
• Spectacles.• Contact Lenses.
• Epikeratophakia. • Intracorneal rings. • Intraocular Lenses.• Refractive surgery.
• Spectacles.• Contact Lenses. • Epikeratophakia. • Intracorneal rings. • Intraocular Lenses.• Refractive surgery.
• Spectacles.• Contact Lenses. • Epikeratophakia. • Intracorneal rings. • Intraocular Lenses.• Refractive surgery.
• Amblyopia
• Amblyopia is a condition in which a unilateral or bilateral decrease in form vision (visual acuity) occurs that is not fully attributable to organic ocular abnormalities. It is caused by deprivation of form vision, abnormal binocular interaction, or both, during visual immaturity (from birth to six years of age(
DIAGNOSISVISUAL ACUITY
NEUTRAL DENESTY FILTER
GRATTING ACUITY
Difference of two lines in BCVA
VA affected ( organic lesion)
VA not affected (Amblyopia)
MANAGEMENT
• Establish a clear retinal image
• Correct ocular dominance
MANAGEMENT
MANAGEMENT• Establish a clear retinal image• Patients with high hypermetropia should be given full
hypermetropic correction• Patients with large astigmatism (over 2.5 to 3 Diopters) must be
fully corrected to prevent amblyopia
• Correct ocular dominance
MANAGEMENT• Establish a clear retinal image• Patients with high hypermetropia should be given full
hypermetropic correction• Patients with large astigmatism (over 2.5 to 3 Diopters) must be
fully corrected to prevent amblyopia
• Correct ocular dominance• Patching
• Penalization
• Pleoptics
MANAGEMENT• Establish a clear retinal image• Patients with high hypermetropia should be given full
hypermetropic correction• Patients with large astigmatism (over 2.5 to 3 Diopters) must be
fully corrected to prevent amblyopia
• Correct ocular dominance• Patching; Partial occlusion is given by doing
less than full-time , opaque occlusion or with translucent occlusion
• Penalization
• Pleoptics
Thank YouThank You