ATARACT SURGICAL PEARLS
Congenital Cataract Surgery Tips from Experts by Tan Sher Lynn
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congenital cataract is the clouding of the lens of an infant’s eye, which happens before birth or during the first year of life. To enable normal vision development and prevent amblyopia or even blindness, congenital cataracts are typically removed by cataract surgery while the child is still an infant. During a CyberSight live webinar on congenital cataracts, held in August last year, Dr. Donny Suh, chief of pediatric ophthalmology and adult strabismus, Children’s Hospital and Medical Center, USA, and Dr. Serena Wang, associate professor at UT Southwestern Medical Center, USA, discussed various surgical techniques, instruments and tips for successful congenital cataract surgery.
Dr. Suh on surgical planning and other important considerations In his practice, Dr. Suh usually operates when the baby is between 4 and 10 months old for unilateral dense congenital cataracts, and between 2 and 3 months old for bilateral dense cataracts. “Studies have shown that the risk of glaucoma is higher when cataract surgery is performed at less than 4 weeks of age,” he shared. “For bilateral cataracts, I usually wait two to four weeks before operating on the other eye. Bilateral surgery on both eyes on the same day is typically not recommended, with the exception of certain countries, where the cost and the risk of anesthesia is high, or
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when the treatment is not readily available,” Dr. Suh added. He stressed the importance of pre-surgery planning, which plays a critical role in ensuring surgical success. Factors he takes into consideration when planning for cataract surgery include: anterior chamber depth, size of eye/pupil, location of cataract, trauma, anterior segment dysgenesis, zonules status, and other anatomical abnormalities. Dr. Suh added that there are four factors which can cause a poor prognostic: unilateral cases, microphthalmia, other associated ocular abnormalities and systemic disease (e.g., uveitis). “In my opinion, the most important aspect of cataract surgery, in pediatric as well as adult patients, is the anterior capsulotomy,” Dr. Suh said. “If you don’t have a good view of the anterior capsule, the surgery could become disastrous in a matter of a second. In order to avoid problems with the lens dislocating, the anterior capsulotomy opening should ideally
| Dec 2020/Jan 2021
be 5mm in diameter and the posterior capsule opening should be about 4mm, since the posterior chamber intraocular lenses (PC IOL) diameter is 6mm. If you make the anterior capsule opening bigger than that, there’s a chance of prolapse,” he explained. Another important consideration is whether or not to place the IOL. “Relative contraindications for IOL placement include chronic inflammatory disease such as juvenile
