QuizWise 14

  1. Subluxation of the lens can be due to the following causes except-
    a. Congenital
    b. Homocystinuria
    c. Weill-Marchesani syndrome
    d. Alport Syndrome
  2. Which of the following may not be used as a management option for childhood Ectopia lentis?
    a. Posterior chamber intra-ocular lens
    b. Anterior chamber Iris fixed intra-ocular lens
    c. Leaving aphakic with spectacle correction
    d. Leaving apkakic with contact lens correction
  3. Which of the following is the most common complication post-pediatric IOL implantation surgery?
    a. Angle recession glaucoma
    b. Optic capture
    c. Visual Axis obscuration
    d. Retinal detachment
  4. What IOL type is considered best to be implanted in the bag in pediatric eyes?
    a. Hydrophobic acrylic single piece IOL
    b. Hydrophobic acrylic three piece IOL
    c. Hydrophilic acrylic single piece IOL
    d. Hydrophilic acrylic three piece IOL
  5. Which of the following is a complication of post-pediatric IOL implantation surgery ?
    a. Uveitis
    b. Glaucoma
    c. Retinal Detachment
    d. Cystoid macular edema
    e. All of the above

Answers:-

  1. d
    Dislocations of the lens can be classified as congenital (ectopia lentis) and acquired.
    Ectopia lentis can emerge in homo cystinuria (bilateral subluxation of the inferonasal lens), in the Marfan syndrome (subluxation of the superior and bilateral lens) and in the Weill-Marchesani syndrome (microspherophakia).

The acquired dislocations of the lens can be traumatic (the most frequent cause), spontaneous (secondary to other ocular pathologies) and postsurgical. Spontaneous luxations occur due to rupture of the zonular fibres as a consequence of degenerative and inflammatory in long-standing glaucoma, high myopia, hypermature cataract, retinal detachment (RD) and pseudoexfoliation syndrome. Cataract post-surgical luxations due to rupture of the posterior capsule are relatively frequent and in many cases entail the collapse of a nuclei fragment which usually does not exceed half (a full collapse is rare).

González-Castaño C, Castro J, Alvarez-Sánchez M. Luxación del cristalino: etiología y resultados [Subluxation of the lens: etiology and results of treatment]. Arch Soc Esp Oftalmol. 2006;81(8):471‐478. DOI: 10.4321/s0365-66912006000800008

2. b
Short-term outcomes (9–16 months) with ACIOLs have been reported to provide good visual outcomes in young patients with no significant complications. However, ACIOL implants in the pediatric population generally have had significant long-term complications, such as endothelial cell loss, corneal decompensation, iris-sphincter erosion and pupillary ectopia. Because of these problems, posterior-chamber SFIOLs are generally preferred over ACIOLs in aphakic children with inadequate capsular support for PCIOL implantation

Reference: Hsu HY, Edelstein SL, Lind JT. Surgical management of non-traumatic pediatric ectopia lentis: A case series and review of the literature. Saudi J Ophthalmol. 2012;26(3):315‐321. DOI: 10.1016/j.sjopt.2012.05.001

3. b
The most common ocular complication was visual axis opacity, including PCO, secondary membrane or lens reproliferation, and capsular phimosis.The prevalence of PCO has been reported to range between 14% and 72% in different studies with different age groups, surgical techniques, and IOL types. When opacification has occurred, the ophthalmologist should consider Nd:YAG laser capsulotomy under general anesthesia or surgical membranectomy as soon as possible.

Reference: Demirkılınç Biler, Elif et al. “Long-term Results in Pediatric Developmental Cataract Surgery with Primary Intraocular Lens Implantation.” Turkish journal of ophthalmology vol. 48,1 (2018): 1-5. doi: 10.4274/tjo.80947

Other Complications-
IOL capture is a one of the early complications that can be the main reason for lack of visual improvement after cataract surgery. Postoperative cystoid macular edema is not as prevalent in children as it is in adults, but it is one of the possible mechanisms of visual impairment postoperatively.
The most important complication of any intraocular surgery in children is postoperative uveitis or severe fibrinous reaction. The pathophysiology of this complication can be explained by the fact that children usually demonstrate harsh and vigorous inflammatory response during the healing process. 
Secondary glaucoma is a common finding in children undergoing congenital cataract surgery. Both types of glaucoma may be seen: open angle and angle closure glaucoma. Mechanisms of secondary glaucoma can be attributed to postoperative inflammation or structural and anatomical destruction as a result of surgery.
Lifelong risk of retinal detachment is increased in children after cataract surgery. This complication increases in myopic children and patients with history of multiple operations. 

Reference: Mohammadpour M, Shaabani A, Sahraian A, et al. Updates on managements of pediatric cataract. J Curr Ophthalmol. 2018;31(2):118‐126. DOI: 10.1016/j.joco.2018.11.005

4. a
Hydrophobic acrylic IOL’s have become the preferred IOL choice for most pediatric cataract surgeons instead of the PMMA IOLs which were once the IOLs of choice. Being foldable, these IOLs offer all the benefits of smaller incision cataract surgery. Further, the hydrophobic acrylic material has excellent biocompatibility and is reported to cause lesser and more delayed onset VAO. A single-piece design is usually preferred for in the bag implantation, whereas the three-piece design is the choice for sulcus implantation or optic capture through anterior/posterior capsulorhexis.

Reference: Vasavada AR, Vasavada V. Current Status of IOL implantation in pediatric eyes: an update. Expert Rev Med Devices. 2017;1‐9. DOI: 10.1080/17434440.2016.1271706

5. e
IOL capture is a one of the early complications that can be the main reason for lack of visual improvement after cataract surgery. Postoperative cystoid macular edema is not as prevalent in children as it is in adults, but it is one of the possible mechanisms of visual impairment postoperatively.
The most important complication of any intraocular surgery in children is postoperative uveitis or severe fibrinous reaction. The pathophysiology of this complication can be explained by the fact that children usually demonstrate harsh and vigorous inflammatory response during the healing process. 

Secondary glaucoma is a common finding in children undergoing congenital cataract surgery. Both types of glaucoma may be seen: open angle and angle closure glaucoma. Mechanisms of secondary glaucoma can be attributed to postoperative inflammation or structural and anatomical destruction as a result of surgery. Lifelong risk of retinal detachment is increased in children after cataract surgery. This complication increases in myopic children and patients with history of multiple operations. 

Reference: Mohammadpour M, Shaabani A, Sahraian A, et al. Updates on managements of pediatric cataract. J Curr Ophthalmol. 2018;31(2):118‐126. DOI: 10.1016/j.joco.2018.11.005

× Hello!
%d bloggers like this: