A wide range of technologies can impact outcomes in young ophthalmic patients.
This article was reviewed by Ken K. Nischal, MD, MBBS, FRCOphth
New devices for use in pediatric surgeries are making challenging procedures less so. Ken K. Nischal, MD, MBBS, FRCOphth, described how he benefits from use of the bag-in-the-lens (BIL), precision pulse capsulotomy, and integrated intraoperative optical coherence tomography (OCT) in children, whose tissues react differently from those of adults.
According to Dr. Nischal, the new technologies can positively impact the surgical outcomes in these patients.
This innovation, developed by Mary Jose Tassignon, MD, and colleagues in 2005 (Verh K Acad Geneeskd Belg 2005;67:277-88), involves creation of one opening of the same size in both the anterior and posterior capsules. A lens that is grooved fits by placement of two leaves into the groove.
“This results in sequestration of the lens epithelial cells and thus elimination of opacification in the visual axis,” according to Dr. Nischal, division chief and professor ophthalmology, University of Pittsburgh and Children’s Hospital of Pittsburgh of the University of Pennsylvania Medical Center, Pittsburgh.
Dr. Tassignon developed foldable rings to ensure creation of a precise capsulotomy. The rings are placed on the capsule and covered with a viscoelastic agent and serve as a template to create the opening.
“If surgeons are having difficulties doing pediatric cataract surgeries, the rings can be used to get the correct sizing of the opening,” Dr. Nischal said. “Even though a child’s capsule is elastic, this works.”
A posterior capsulorhexis is created using the anterior opening as the template. He explained that in a 4-year-old child. The lens appeared the same two years postoperatively as it did on the first day postoperatively, with a perfectly clear visual axis.
There is a learning curve attached to this procedure, in that it can be difficult to get the two capsules anchored into the groove, Dr. Nischal noted.