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PAOLO BORDIN, GABRIELE VIZZARI; A NEW SURGICAL TECHNIQUE IN CONGENITAL CATARACT WITH FEMTOSECOND LASER. Invest. Ophthalmol. Vis. Sci. 2016;57(12):934.
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© ARVO (1962-2015); The Authors (2016-present)
The aim of this study is to describe a technique for performing cataract surgery with a femtosecond laser (FLACS) in infants with bilateral polar cataract, by using a viscoelastic substance to visualize the posterior capsule.
A 2-year-old male presented with bilateral polar cataract visualized on slitlamp examination. His best-corrected visual acuity (BCVA) was 20/200 in OD and 20/100 in OS. The keratometry (SRK-Tformula) is obtained with IOL Master and the axial length with Ultrasound biomicroscopy. He underwent bilateral FLACS (Victus,B&L) followed by implantation of a intraocular lens (IOL). Anterior capsulotomy of 5 mm is performed by the laser. The eye has been opened for lens aspiration without complications. A capsular tension ring is implanted in the bag using a cohesive viscoelastic substance to avoid the future phimosis. A hole is created in the posterior capsule using a 27G needle and filled a short-chains viscoelastic device through the gap in the vitreal chamber, between the posterior capsula and the hyaloid. A new docking of the laser is performed after the closure of the corneal wounds. The real time-integrated optical coherence tomography (OCT) also visualizes the posterior capsule pushed up by the viscoelastic, allowing a centered central posterior capsulotomy of 4.5 mm, followed by mechanical anterior vitrectomy. A IOL is implanted in the bag of both eyes.
The child was followed up on day 1, day 5, at 2 weeks, 4 weeks and 8 weeks. At each follow-up visit, complete ocular examinations including orthoptic examination of both eyes were performed.The cornea was clear and the intraocular pressure(IOP) was 15mmHg in OU at every visit.At 4 weeks the BCVA was 20/30 in OU.Anterior and posterior capsulotomies were complete and uniform, without tears. The IOL was centered in the bag. No complications were encountered.
The technique has been performed in a infant with congenital cataract and it can enhance the quality of pediatric cataract surgery.The capsule is very elastic and tends to tear peripherally in manual anterior capsulotomy.This can induce to a complete loss of the capsule protection during surgery, with damage of the capsular scaffold for the IOL placement. Using the viscoelastic to push up the capsule allow a better visualization of the capsular surface,in order to standardize the laser capsulotomy procedure and to obtain a safe,precise and repetitive surgery.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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