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Strabismus after treatment of unilateral congenital cataracts. A clinical model for strabismus physiopathogenesis?
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
D. Thouvenin, S. Nogue, L. Fontes, O. Norbert
Surgical procedure, treatment of aphakia and patching procedure are usual and have been discussed elsewhere, with monocular visual results [Thouvenin: 1995, 2003]. We although report monocular visual results to be more complete on cases description.
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Aphakia is absence of the lens, most commonly iatrogenic after congenital cataract extraction. Rare causes are spontaneous resorption of a cataract (may be seen in Lowe syndrome and Hallerman–Streiff syndrome), congenital primary aphakia that is extremely rare (usually accompanied by other anterior segment anomalies) and spontaneous complete dislocation of the lens (either traumatic or related to already subluxed lens – see later).
Removal of intraocular foreign bodies
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
William J Wirostko, Sumit Bhatia, William F Mieler, Cathleen M McCabe
Cataract surgery may be required if the lens is lacerated, dislocated, or subluxated. Lens extraction clears a view to the posterior segment and decreases the risk for phacoantigenic endophthalmitis and glaucoma.31 Furthermore, it removes a potential nidus for infectious endophthalmitis. One could consider a limbal approach if both good zonular support and an intact posterior capsule are present, but otherwise a pars plana approach should be employed. Removing the traumatized lens also simplifies the differential diagnosis of post-injury inflammation in an eye at risk for infection. It must be stated that not all lenticular injuries are progressive and that a good visual outcome may be possible with lens preservation.45 Aphakia can be managed with either an immediate or delayed intraocular lens placement. The latter is the traditional and probably safer method. However, it leaves the eye aphakic and requires additional surgery. In contrast, immediate intraocular lens placement offers quick visual rehabilitation, but risks the placement of foreign material in a potentially infected eye. It also potentiates the chance for using the wrong intraocular lens power. Nonetheless, good results have been reported,40,46,47 and immediate intraocular lens placement may be considered if there is a low risk for endophthalmitis. Appropriate informed consent is essential in both strategies.
Secondary Intraocular Lens Implantation (IOL) in Children- What, Why, When, and How?
Published in Seminars in Ophthalmology, 2023
Sakshi Lalwani, Ramesh Kekunnaya
Shenoy et al reviewed visual outcomes of secondary IOL implantation in children and it was seen that the mean age of the surgery and duration between the primary and secondary procedures were less as compared to other published literature. The average age of patients who underwent secondary IOL implantation with good outcome was 6.08±3.75 years.18 The post-operative complications in terms of secondary membrane, rise of intraocular pressure, post-operative inflammation were reported to be less common. The bilateral aphakia patients showed improvement in visual acuity more than unilateral cases. These sulcus fixated IOLs had reasonably good outcomes. In this study the absolute prediction error (PE) was slightly higher as compared to other studies, there was no difference in absolute PE between unilateral and bilateral cases. The absolute PE was better when IOL Master was used as compared to contact biometry.18
Service evaluation: orthoptic-led teaching of soft contact lens handling for parents in the management of pediatric aphakia
Published in Strabismus, 2021
Visually significant, congenital cataracts often undergo early surgery, preferably under 12 weeks of age. The publication of the IOL under 2 study,1 and the Infant Aphakia Study2 showed that primary implantation of an intraocular lens in infancy increases post-operative complications, and need for further surgery. Optical management of aphakia in the absence of intraocular lens implantation is limited to heavy, thick aphakic glasses or contact lenses (CL). CLs have optical advantages, so it is essential parents learn to insert and remove CLs quickly and safely on a daily basis, to reduce infection risks. Infrequent handling of CLs, or poor CL hygiene, and handling technique are risk factors for microbial keratitis, corneal scarring and subsequent visual acuity loss, so quality teaching is vital. Repka et al.3 acknowledges that surgery is only the first step in a difficult and long journey in the management of pediatric aphakia. Infant Aphakia Treatment Study2 and Cromelin4 explain the importance of adherence to amblyopia treatment and contact lenses in relation to long term visual acuity.
Intraocular lens implantation in infants and toddlers in 2020
Published in Expert Review of Ophthalmology, 2020
Pratik Chougule, Ramesh Kekunnaya
IOL implantation was associated with better visual outcomes in dense unilateral or bilateral cataracts as compared to aphakic patients in a study from China, which could be due to higher mean age at surgery (20.3 months) [33]. Another study from Europe also suggested better visual outcomes, improved binocular function with lower incidence of strabismus in the IOL group as compared to the CL group [34]. There is substantial evidence indicating a higher incidence of secondary glaucoma in patients with surgical aphakia compared to pseudophakic infants [35]. IATS also suggested that there is a higher risk of developing sight-threatening complications like endophthalmitis, retinal detachment and phthisis bulbi in cases with surgical aphakia, although not reaching significance, probably due to small study population [2]. Considering that most of the complications in the IOL group such as VAO can be managed better compared to more sight-threatening and challenging complications in aphakic group such as glaucoma, retinal detachment and endophthalmitis, IOL implantation may be considered safer in the long run. Moreover, most aphakic patients will eventually opt for a secondary IOL, which may cause further adverse events [36].