Innovative Implantation Technique by Marie-José Tassignon & Sorcha Ní Dhubhghaill & Luc Van Os

Author:Marie-José Tassignon & Sorcha Ní Dhubhghaill & Luc Van Os
Language: eng
Format: epub
ISBN: 9783030030865
Publisher: Springer International Publishing

The Bochum formula for pediatric laser capsulotomies helps to minimize the age-depending deviation from the targeted diameter [15]. The anterior and posterior laser capsulotomy in children is, according to our experience, safe to perform. Implant IOLs was primarily in children 1 year and older, while secondary implantation was generally planned before the age of 6 years.

The operation is the first step to visual recovery for a child with cataract, to be followed by long-term care provided by the ophthalmologist. The parents (or caretakers) must be educated about the need for continuous follow-up so that complications like inflammation, glaucoma, and PCO can be detected and treated as soon as they arise, refractive errors can be corrected and amblyopia therapy pursued. In the immediate postoperative stage, the parents have to take care to administer pharmacological therapy as recommended by the surgeon or the ophthalmologist in charge of the follow-up. Normally, three different kinds of drugs are instilled as eye drops: antibiotics, anti-inflammatory agents, and maybe mydriatics/cycloplegics.

Antibiotics like fluoroquinolones are generally given for about a week after surgery, in regimens like every 6 h. This group of antibiotics is generally well tolerated; Ciprofloxacin is reported to have minimal adverse systemic side effects and is well tolerated by the corneal endothelium. Fourth-generation fluoroquinolones such as gatifloxacin and moxifloxacin have been successfully employed in children undergoing cataract surgery, both pre- and postoperatively.

Since the inflammatory response to cataract surgery might be quite intense in children, the frequent administration of topical and sometimes even systemic steroids is crucial to reduce the risk of complications like fibrinous membrane formation, synechia, the formation of inflammatory deposits on the IOL, and cystoid macular edema. Topical administration can mean the application of eye drops like 1% prednisolone acetate every 1–6 h or – in extreme cases – the subconjunctival injection of 2–4 mg dexamethasone. Depending on the patient’s clinical presentation, the topical application of steroids – certainly the most common form of postoperative anti-inflammatory therapy – will be continued for up to 12 weeks. In cases where steroid-related complications like delayed wound healing or IOP rise are an issue, NSAID like diclofenac or ketorolac eye drops can be used. The rationale behind the postoperative administration of mydriatics and cycloplegics is pain reduction by dilating the pupil, preventing inflammation, stabilizing the blood-aqueous barrier, and diminishing the risk of synechia, pupillary block, and ciliary spasm.

Since a child’s refractive status frequently changes during the first years of life, examinations are recommended every 2–3 months. Bifocal glasses for these children without accommodation are usually not tolerated before age 5 or 6. Particularly in younger children with an IOL, a considerable myopic shift can be expected [16].

Treating a child with cataract should give the cataract surgeon cause for a small pause in his or her daily routine, a short break in a sometimes overburdening schedule, and an incentive for some reflections: the child just operated upon will carry the marks of our intervention far into the future. The boy or girl of today will during a

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