(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

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