Pediatric Cataract Management Dr Suresh K Pandey CME Program Kota July 23, 2017 скачать в хорошем качестве

Pediatric Cataract Management Dr Suresh K Pandey CME Program Kota July 23, 2017

Pediatric Cataract Management Dr Suresh K Pandey CME Program Kota July 23, 2017 PEDIATRIC CATARACT MANAGEMENT Dr Suresh K Pandey, SuVi Eye Institute & Lasik Laser Center, Kota, Rajasthan Child with Congenital Cataract: Always perform EUA (look for IOP, status of Cornea, Iris, Lens, Retina, etc). Refer to pediatrician for detailed systemic evaluation, investigations and fitness for general anaesthesia. Indications for Surgery: Visually significant Cataract (Central lenticular opacity of 3 mm or more) Timing of Surgery: Unilateral cataracts should be operated on within the first 6 weeks of life to prevent the development of deprivation amblyopia. Bilateral Cataract: Once a visually significant cataract is detected, it should be operated on as early as possible. In symmetrical bilateral cases, the second eye should be operated on within one to two weeks of the first. When there is significant asymmetry, the denser cataract is generally removed first; surgery on the second eye may then be deferred until after the first eye receives optical correction. IOL Implantation: No universal consensus in infants (less than 1 year). Increasing in popularity among children for more than one year. IOL Power Calculation: Under correcting biometry reading by 10% in children between 2 to 8 years. For children younger than 2 years, perform biometry and under-correct by 20% or use the axial length only. Posterior Capsule Management: Less than 2 Years: Posterior Capsulectomy/Posterior Capsulorhexis (PCCC) with Anterior Vitrectomy; Between 2 to 8 Years: Posterior Capsulectomy/Posterior Capsulorhexis without Anterior Vitrectomy; After 8 Years: Leave Posterior Capsule Intact. Surgical Technique: Incision: Wound configurations that are self-sealing in adults often leak when used in children because of the elastic sclera. Even the corneal tissue is less likely to self-seal in children. We recommend suture closure of tunnel wounds and paracentesis openings. CCC: cohesive viscoelastic like sodium hyaluronate 1.4% is recommended for pediatric cataract surgery to facilitate anterior capsulorrhexis as they maintain anterior chamber stability, and help offset the low scleral rigidity and increased vitreous upthrust found in pediatric eyes. IOL Implantation: Single-Piece IOL implantation in preferably in the capsular bag Role of Preservative Free Triamcinolone: Intracameral triamcinolone (Europort 4 mg/0.1 mL) is a safe and useful adjunct in pediatric cataract surgery. All post-operative cases should be followed up carefully for refraction, IOP measurement, visual axis opacification, and amblyopia management. Unlike an adult cataract, the management of a pediatric patient is not complete when the post-operative period is over. In some ways, the more difficult and important part of management is still ahead. Neglecting the treatment and prevention of amblyopia or not giving proper refractive correction is leaving the work half done. Lifelong careful follow-up is essential for all pediatric cataract cases. #DrSureshKPandeyKota #SuViEyeHospitalKota #SuViEyeHospitalLasikLaserCenterKota