Prevention of IOL Laser Damage after YAG Laser Destruction in Children with Secondary Cataract

Background. In recent years there is a tendency to more often admission in our institution children with multiple IOL damage caused by laser treatment of secondary cataract operated at local hospitals.Purpose. To analyze the causes of laser damage to IOL in children underwent YAG laser destruction of secondary cataract and find best ways to prevent them.Patients and methods. We analyzed the frequency of acrylic IOL damage after YAG-laser destruction in 593 children with congenital, posttraumatic and postuveal cataract at age from 6 months to 17 years (one third of patients were less than 3 years old). All laser operations were performed on identical YAG-laser, by the same protocol and by one surgeon.Results. We confirmed that main reliable prevention factor of damage to IOL in children is the precise focus of laser beam. In past 10 years in our institution, we managed to decrease frequency of laser damage to IOL in children with secondary cataract in 4.5 times due to performing operations under general anesthesia (43.8 % in 2007–2008, 65.8 % in 2018). Thus, decreasing frequency from 5.9 % to 1.3 % in the same age group of patients.Conclusion. To achieve the effective prevention of laser damage to IOL in cases of YAG laser destruction of secondary cataract it is essential to use general anesthesia in following conditions: children 5 or below age, non-contact children of older age, children with nystagmus, CNS pathology, psychomotor development delay. It is unacceptable to perform this operations without general anesthesia in children that can’t fix the gaze. Furthermore it is important to use contact lenses to fix the eyes of a child, select the individual less invasive method and technique of laser operation, utilize single short impulses with minimal effective energy, thoroughly follow standard safe energy modes (impulse energy shouldn’t be more than 2.4 mJ, impulse number should be not more than 100).

Artificial lens replacement in own experiences. What determines the success of this procedure?

The article describes the author’s experiences related to the replacement of an artificial lens with a different model. Reasons for the procedure are described and attention is paid to the stages of lens removal that may affect the final result of the procedure. Lens replacement procedures were performed by one surgeon in the period from one month to over 6 years from the initial implantation procedure. Calcification, glistening and subsequent opacification of the artificial lens are among the main reasons for removing an artificial lens after several years. Removal of the lens in a short time, up to 15 months, resulted from the desire to see without glasses to far and near distances, the presence of a residual defect, and the quality of vision unacceptable to the patient related to the implantation of a premium class lens. The presence of secondary cataract greatly facilitates the lens replacement process.

Optical coherence tomography of pseudophakic eyes after primary posterior capsulorhexis in pseudoexfoliation syndrome

Purpose to study vitreolenticular interface (VLI) and central retinal thickness after primary posterior capsulorhexis (PPC) in pseudoexfoliation syndrome (PEX). Material and methods. We conducted a dynamic OCT-evaluation of the macular morphology (47 cases) and of the VLI (39 cases) in patients with PEX in early and long term period after uncomplicated cataract surgery with PPC. In the long term period a comparative OCT-evaluation of the macula was performed in 129 patients with PEX (159 eyes) in different groups: after phacoemulsification with and without PPC, after Nd:YAG laser capsulotomy for secondary cataract, and in the control group of non-operated eyes. Results. The OCT-evaluation made it possible to visualize two significant features of VLI after PPC intact anterior hyaloid and restoration of the capsule barrier. It took 38 days for full adhesion. Secondary cataract in the PPC area was detected in one case in the long-term period. Dynamic OCT-evaluation of the macula in the main group revealed a statistically unreliable increase in the macular thickness (3.4%) in post-op period at 13 months with subsequent regression. Such changes were within the limits of physiological norm. In the remote period, comparative OCT-evaluation of the macula in different groups did not reveal statistically significant differences with the control group. Conclusion. OCT-evaluation at different post-op terms revealed the formation of stable vitreolenticular relationships and absence of clinically significant macular edema. Secondary cataract in the PPC area was detected only in one case.

Study of frequency and structure of secondary cataract formation with various types of interface «IOL –posterior lens capsule» in long term after phacoemulsification of senile cataract

Актуальность. Вторичная катаракта (ВК) является самым распространённым осложнением отдаленного послеоперационного периода факоэмульсификации (ФЭ). Один из факторов профилактики ВК – оптимальный интерфейс «интраокулярная линза – задняя капсула хрусталика» (ИОЛ – ЗКХ), так как полная адгезия вышеуказанных структур препятствует миграции эпителиальных клеток хрусталика c периферии ЗКХ в ее оптическую зону. Цель. Изучить частоту и структуру ВК при различных типах интерфейса «ИОЛ – ЗКХ» в отдаленные сроки после ФЭ возрастной катаракты. Материал и методы. Обследовано 416 пациентов (416 артифакичных глаз). Нами был исследован тип интерфейса «ИОЛ – ЗКХ» с помощью оптического когерентного томографа (RTVue-100, Optovue, США) с модулем для исследования переднего отрезка по протоколу Cornea Line и Cornea Cross Line через 1 и 2 года после операции, оценивали структуру и прозрачность ЗКХ. Результаты. Через 1 год после ФЭ различные помутнения ЗКХ были выявлены в 24 глазах (5,8%), через 2 года – в 62 глазах (14,9%). Наибольшее число помутнений ЗКХ отмечалось в глазах с отсутствием контакта или неполным контактом ИОЛ с ЗКХ, наименьшее – с полным контактом ИОЛ с ЗКХ. Выводы. Проведенные исследования показали, что частота и структура ВК в различные сроки после ФЭ зависит от типа интерфейса «ИОЛ – ЗКХ». Наименьшая частота формирования ВК через 2 года после ФЭ отмечена в артифакичных глазах с полным контактом ИОЛ с ЗКХ (3 глаза – 2,2%).

Concurrent Phacoemulsification and Encircling for Hypotony Maculopathy after Blunt Trauma

A 37-year-old Japanese man had his right eye hit by a fist. His right eye developed hypotony maculopathy and secondary cataract, and his visual acuity decreased to 20/200 with an intraocular pressure of 4 mmHg. He underwent phacoemulsification and aspiration, implantation of the intraocular lens, and encircling with a silicone tire. His visual acuity improved to 20/20 and stable for more than one year postoperatively. The intraocular pressure in his right eye increased to 12 mmHg, and maculopathy was resolved entirely. It was suggested that an encircling buckle obstructed the uveoscleral outflow through the cyclodialysis and increased intraocular pressure. Concurrent cataract surgery and encircling was sufficient to improve the vision.