Management in Descemet's membrane detachment after cataract surgery--case report

Descemet's membrane detachment (DMD) is a rare, but serious complication of cataract surgery. It can cause permanent corneal edema that results in severe visual loss. Small detachments resolve with topical medical therapy within few weeks to few months. Larger detachments usually require surgical intervention. We present a case report of a patient with Descemet's membrane detachment that occurred one day after complicated phacoemulsification cataract surgery. At 3 months after surgery visual acuity was 3/50 and persistent corneal edema was observed. Anterior chamber tamponade with air under topical anesthesia successfully reattached Descement's membrane. The corneal edema regressed and the gas bubble resolved by the fifth day after surgery. Patient's left visual acuity was 5/12. The intraocluar pressure was 17 mmHg. We believe this method is safe, effective and results in fast visual acuity improvement.     

先天性白内障手术中预防后发障的方法

目的　探讨小儿先天性白内障手术中预防后发障的方法。方法　对 46例 ( 4 6眼 )先天性白内障 ,以白内障超声乳化仪的注吸I/A系统吸净晶状体植入人工晶状体后 ,进行后囊连续环形撕囊及前段玻璃体切除联合手术 (A组 ) ,同期施行的3 2例 ( 3 2眼 )先天性白内障 ,以同样的方法行白内障摘出人工晶状体植入后 ,进行单纯后囊连续环形撕囊术 ,不做前段玻璃体切除 ,作为对照组 (B组 )。术后随访 2年以上。结果　后发障发生的情况 ,A组 2眼 ( 4 4% ) ,B组 7眼 ( 2 1 9% ) ,两组对比差异具有显著性意义 (P <0 0 5 )。两组均未发现眼底并发症。结论　先天性白内障术中行后囊连续环形撕囊联合前段玻璃体切除术 ,是预防后发性白内障的有效方法。     

Autosomal dominant congenital cataract. Morphology and genetic mapping

We studied a large Danish pedigree with autosomal dominant congenital cataracts (ADCC) in 9 generations. Morphological characteristics of the cataracts are described and documented by photos. In contrast with several other types of ADCC the cataracts studied were progressive during infancy and childhood. Linkage analysis with 14 marker systems revealed close linkage between this Marner cataract locus (CAM) and the locus of Haptoglobin (HP) on chromosome 16. Genetic heterogeneity in ADCC has now established with the genetic mapping of cataract loci to chromosome 1, chromosome 2, and chromosome 16.     

Anophthalmia and congenital cataract: case report

The authors report a case of anophthalmia, congenital cataract and systemic malformations. Male patient, 6 months old, left anophthalmia and congenital posterior polar cataract in the right eye. The patient was treated with manual aspiration of the crystalline lens, with no intraocular lens implantation with primary posterior capsulorhexis and anterior vitrectomy through a small incision. The association of anophthalmia and congenital cataract is rare. The early diagnosis and management in these cases is very important for the best visual rehabilitation.     

The therapeutical approach in the unilateral congenital cataract of the child

The management of pediatric cataracts is, by far, more complex than the management of cataracts in adults and depends not only on deterioration of visual acuity, but also on the status of the other eye, the general health of the child, the motivation and the financial situation of the parents and last, but not least, on the surgeons' experience and skill, and the technical support. The therapeutically approach involves: the preoperative evaluation to establishes the indication and the timing of surgery the adaptation of the surgical technique for each case the choice of the aphakic correction the visual rehabilitation in the context of amblyopia management.     

Surgical management of suprachoroidal haemorrhages induced by cataract surgery--case series

Purpose: Suprachoroidal hemorrhage (SCH) is a rare complication occurring during surgery (early SCH) or 3-5 days after operation as a delayed suprachoroidal hemorrhage. It occurs more often in patients who have complicated cataract surgery with vitreous loss or lens dislocation. The purpose of this study was to present surgical treatment of 7 patients with suprachoroidal hemorrhage due to cataract surgery. Material and methods: Mean age of patients was 72,4 years old. There were 3 female and 4 male. Six patients were operated using phacoemulsification, one patient- using ECCE. In 3 cases the vitreous loss and lens dislocation occurred during operation. Results: Suprachoroidal drainage was performed in 4 patients. In 3 patients suprachoroidal drainage was followed by vitrectomy. In this group in 2 patients injection of silicone oil was done. Anterior infusion line was used in all cases. Drainage sclerotomies were created in the quadrants of the involved SCH, confirmed by ultrasonography. In all treated patients reattachment of the choroid was obtained. The visual acuity improved significantly (final v. a. was between 0. 02 and 0. 5). Conclusions: According to our observation, the implementation of the suprachoroidal drainage combined with vitrectomy might improve the prognosis and facilitate the achievement of functional vision.     

Glaucoma secondary to pars plana lensectomy for congenital cataract

BACKGROUND: To identify risk factors related to the onset of secondary glaucoma in eyes that have undergone pars plana lensectomy for congenital cataract. METHODS: We investigated intraocular pressure levels after pars plana lensectomy for congenital cataract in 80 eyes of 44 patients who were followed up for at least 36 months. Mean age at the time of pars plana lensectomy was 11+/-18 months. Mean follow-up period was 116+/-57 months. RESULTS: An elevation in intraocular pressure (>20 mmHg) was found in 21 eyes of 12 patients (26%). In 7 of these 21 eyes surgical treatment was required. The incidence of the coexistence of microcornea (or microphthalmos) with congenital cataract was significantly higher in the glaucoma group than that in nonglaucoma group. The final visual acuity in the nonglaucoma group was significantly better than that in the glaucoma group. CONCLUSION: Our results show the importance of careful follow-up of intraocular pressure after pars plana lensectomy for congenital cataract, especially when microcornea (or microphthalmos) is present.     

Efficacy of microcatheter-assisted trabeculotomy on secondary glaucoma after congenital cataract surgery

AIM: To evaluate efficacy of microcatheter-assisted trabeculotomy (MAT) in eyes with secondary glaucoma after congenital cataract surgery and explore its correlation with the different degree of trabeculotomy. METHODS: A retrospective analysis was conducted on patients who underwent the said procedure between September 2019 and September 2020. The patients were classified into two groups according to the degree of trabeculotomy (group 1: ≤240-degree; group 2: 240–360-degree). The intraocular pressure (IOP) and anti-glaucoma drugs before and after operation was collected during the 12-month follow-up. RESULTS: Totally 27 eyes of 25 patients were included: 11 (40.7%) eyes in group 1 and 16 (59.3%) eyes in group 2. The mean IOP of all patients was 34.67±9.18 mm Hg preoperatively and 8.74±4.32, 9.95±5.65, 14.39±5.30, 16.02±4.37, 15.82±3.28, and 16.19±3.56 mm Hg 1d, 1wk, 1, 3, 6, and 12mo after surgery, respectively. In all patients, there were significant differences in IOP at each time point (F=65.614, P<0.01). In each group, IOP after surgery was lower than that before surgery (all P<0.01), but there was no difference in the rate of IOP reduction between the two groups (P=0.246). Furthermore, the amount of anti-glaucoma medications reduced to 0.30±0.67 (0–2) at 12mo from 2.63±0.49 (2–3) preoperatively (P<0.01), and there was no difference between the two groups (P>0.05). At the end of follow-up, the partial success rate was 81.8% in group 1 vs 93.75% in group 2 (P=0.549). Various amount of intraoperative and postoperative hyphema occurred in all eyes, which spontaneously absorbed or cleaned through paracentesis and irrigation. No other serious complications was observed. CONCLUSION: MAT can effectively reduce IOP in patients with secondary glaucoma after congenital cataract surgery with a high success rate and safety. And it can be used as the first choice for the treatment of secondary glaucoma after surgery for congenital cataracts.     

先天性白内障二期后房人工晶状体植入不同技术方法的探讨

目的探讨分析先天性白内障二期后房型人工晶状体植入术的不同技术方法、效果及可能出现的并发症。方法对27例(36眼)已行先天性白内障摘除的无晶状体眼患儿行二期后房型人工晶状体植入术,包括眼前节重建、后囊膜撕开或切开、前部玻璃体切除及人工晶状体缝线固定等技术。术后观察分析视力、人工晶状体及后囊膜情况及其他并发症。结果术后第3天视力>0.5者8眼,0.5以下者28眼;术后1个月矫正视力>0.5者12眼,0.5以下者24眼;术后3个月矫正视力>0.5者17眼,0.5以下者19眼。术后1个月发现残留后囊膜混浊10例,人工晶状体前纤维膜2例,人工晶状体位置良好,无夹持或脱位。观察6个月,无眼后节并发症,但屈光度的变化尚需长期观察。结论二期后房型人工晶状体植入术是治疗2岁以上儿童无晶状体眼的最佳方法,需要熟练掌握处理复杂情况的显微手术技巧和经验。     

Risk factors for secondary membrane formation after removal of pediatric cataract

PURPOSE: To evaluate the incidence of secondary membrane formation, factors that lead to its development, and the frequency of procedures to treat these membranes in children after cataract surgery. SETTING: Department of Pediatric Ophthalmology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. METHODS: Clinical records of 152 patients (190 eyes) who had cataract extraction between January 1986 and 1996 were reviewed retrospectively. The mean follow-up was 6 years (range 2 to 13 years). Cataract surgery was performed through a limbal incision in all cases. Twenty-eight eyes had a primary posterior capsulectomy, and 120 eyes had posterior capsulectomy combined with an anterior vitrectomy. In 42 eyes, the posterior capsule was left intact. Nineteen eyes received a primary intraocular lens (IOL), 15 eyes received a secondary IOL, and 156 eyes were rehabilitated with spectacles or contact lenses. RESULTS: Seventy-two eyes (37.9%) developed secondary membrane a mean of 8.9 months postoperatively (range 3 weeks to 53 months). Membranes occurred in 78.6% of eyes with an intact posterior capsule, 42.9% with posterior capsulectomy, and 22.5% with combined posterior capsulectomy and anterior vitrectomy. Secondary membrane formation was associated with not performing a posterior capsulectomy with anterior vitrectomy (P < .001) and the presence of a primary IOL (P < .001). Younger age at surgery increased the chance of secondary membrane formation in patients who had posterior capsulectomy and anterior vitrectomy (P < .01). CONCLUSIONS: The younger the child at cataract surgery, the greater the risk of secondary membrane. Primary posterior capsulectomy combined with an anterior vitrectomy decreased but did not eliminate the incidence of secondary membrane.     

Possible changes in secondary structure and composition of human lens capsules in hereditary congenital cataract

Background: Scanty information is available on the changes in conformational structure and composition of human lens capsule in cases of hereditary congenital cataract. The purpose of this study was to use Fourier-transformed infrared (FT-IR) spectroscopy to determine the secondary structure and composition of hereditary cataractous human lens capsule, as compared with normal human lens capsule. Methods: FT-IR spectroscopy with the Fourier self-deconvolution and curve-fitting program was performed, and second-derivative analysis was used to verify the peak positions and assignments of the IR spectra. Results: The curve-fit FT-IR spectra revealed that the content of hydroxylysine and arginine were clearly higher in the lens capsule of the hereditary congenital patient, but the content of aspartic acid significantly lower, than in normal human lens capsules. The secondary conformational changes in a-helix, triple helix and random coil structures were important findings in the lens capsule of a hereditary cataractous patient. Conclusion: Possible alterations in secondary structures and compositions of lens capsule are observed in the hereditary congenital cataractous patient by using FTIR spectroscopy with curve-fitting and second-derivative analysis.