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An Approach to Visual Loss in a Child
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Muhammad Hassaan Ali, Stacy L. Pineles
There is almost 100% rate of posterior capsular opacification in children after cataract surgery. In all such cases, primary posterior capsulotomy and anterior vitrectomy up to the age of 6–7 years are recommended. The anterior vitrectomy removes the solid vitreous base. The pars plana is generally avoided in children since this approach may cause suprachoroidal hemorrhage. Vitrectomy through the limbal side ports is also relatively easier for the surgeons who are trained in the anterior segment. Some surgeons prefer to perform capsulorrhexis of the posterior capsule. In such cases, anterior vitrectomy need not be performed since the vitreous phase is not disturbed. The preferable lens material for IOL in children is either hydrophobic acrylic or polymethyl methacrylate. If the children are cooperative and able to sit properly on slit amp, Nd:YAG laser capsulotomy can be done over 6 years of age after surgery (48).
YAG Laser
Published in Anita Prasad, Laser Techniques in Ophthalmology, 2022
Posterior capsular opacification is the commonest late complication of cataract surgery, causing blurred vision, glare, reduced contrast sensitivity, and monocular diplopia. A unilateral PCO can reduce binocularity and stereopsis, and affect QoL.
Surgical Approaches and Steps
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
In EASB, instead of using an indirect ophthalmoscope, visualization of the internal operative field is achieved using self-retaining endoilluminator [chandelier] or cannula-supported endoillumination and wide-angle viewing lens [contact or non-contact]. Technological advances have enabled commercial availability of small-gauge (23G, 25G, 27G) powerful light sources for endoillumination, and these can be placed at a desired location through the pars plana. Our initial surgeries were performed using the Awh 25G self-retaining endoilluminator connected to a Photon (Synergetic) light source. Reinverting Operating Lens System [Volk] lenses were used for wide-angle viewing. Once there is endoillumination, wide-angle-viewing lenses enable visualization of the retina up to the ora serrata. Scleral indentation can be performed by the surgeon sitting at the microscope without having to wear an indirect ophthalmoscope and move around the operating table. Visualization is excellent even in the presence of non-dilating pupil, posterior capsular opacification, or early cataract. With this approach, it is not only possible to locate the number and location of breaks more accurately while seated at the microscope but also to undertake cryopexy of the breaks, drainage of subretinal fluid at a site where the height of detachment is maximum, and titrate the buckle height to achieve an ideal buckle–break relationship. The self-retaining endoilluminator can be removed at the end of the procedure after looking for induced retinal arterial pulsation. The site where the endoilluminator was placed may need to be closed with a single stitch in some patients. The surgical steps are highlighted in Figure 9.12a-d. Figure 9.13 shows preoperative and postoperative fundus photos of an early patient with retinal detachment repaired successfully with this technique.
Association between Increased Cataract Surgery Duration and Postoperative Outcomes
Published in Ophthalmic Epidemiology, 2023
Ashton Kalhorn, Jennifer L Patnaik, Cristos Ifantides, Cara E Capitena Young, Anne M. Lynch, Karen L Christopher
The significance and cause of increased likelihood of Nd:YAG laser capsulotomy in the long surgery group is unclear. Multifocal lenses were more common in the long surgery group and tend to undergo earlier Nd:YAG capsulotomies than monofocal lenses.15 However, this was controlled for in the multivariate analysis. We suggest that these longer cases, while not formally defined as complex, may have been more difficult cases and, therefore, it is more likely that the surgeon may have felt less comfortable removing additional residual lens epithelial cells from the capsular bag leading to a higher rate of early formation of posterior capsular opacification. It is important to note potential risk factors for development of posterior capsular opacification including IOL geometry, IOL placement, surgical technique, and cortical clean-up were not measured in our database and could not be accounted for in this analysis.16
The protective effect of beta-casomorphin-7 via promoting Foxo1 activity and nuclear translocation in human lens epithelial cells
Published in Cutaneous and Ocular Toxicology, 2018
Lihua Zhu, Jia Li, Dayang Wu, Bing Li
DCs are ocular complications that result from uncontrolled DM. Although cataract surgery has been greatly improved thanks to the development of surgical methods40, the incidence of posterior capsular opacification (PCO) is still high after cataract surgery41. Also, the oxidative stress reduced by hyperglycaemia remains the main cause of capsular opacification. Zaczek et al.42 found less PCO occurrence in normal patients than those under hyperglycaemic conditions after a DC operation. Moreover, diabetic patients undergoing cataract surgery are more predisposed to dry eye syndrome and complications43. However, the mechanism of the discrepant findings in PCO formation and postoperative complications between patients with diabetes and without diabetes remains unclear. Understanding this is crucial for the study of effective drugs to inhibit oxidative stress in DC.
Natural history of Usher type 2 with the c.2299delG mutation of USH2A in a large cohort
Published in Ophthalmic Genetics, 2022
Audrey Meunier, Xavier Zanlonghi, Anne-Françoise Roux, Jean-François Fils, Laure Caspers, Isabelle Migeotte, Marc Abramowicz, Isabelle Meunier
Cataract classically consisted of a posterior capsular opacification leading to a rapid VA degradation. Patients carrying the c.2299delG mutation developed phacosclerosis earlier than the other USH2A patients, with a mean age of 36.3 y.o. ± 9.1 versus 42.2 y.o. ± 12.0 (p = 0.0437) for other genotypes. At the first consultation, 46.8% of patients already presented phacosclerosis, and 9.3% had undergone phacosurgery. No statistical difference between these two subgroups was found regarding the age of phacosurgery: the mean age for the c.22999delG group was 42.5 ± 7.8 versus 48.6 ± 12.1 for other USH2A patients (p = 0.173).