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Pediatric Cataract Surgery in the Abnormal Anterior Segment

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Pediatric Cataract Surgery and IOL Implantation

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Abstract

This chapter addresses challenges encountered during pediatric cataract surgery in eyes with abnormal anterior segments. Adjustments to the operating microscope to maximize depth perception or the red reflex, as well as the use of an endoilluminator, are discussed for improving the view in cases of corneal opacities such as scars, failed grafts, Peters anomaly, or corneal dystrophies. For iris abnormalities such as posttraumatic iris adhesions, synechiae, hypoplastic iris tissue, and persistent miosis, the effective use of ophthalmic viscosurgical devices (OVDs) and microscissors are explained. Techniques for improving surgical incisions in small anterior segments are offered. In order to achieve stable centration of an IOL in a large anterior segment, the anterior capture of a three-piece IOL with the optic in the capsular bag and the haptics in the sulcus is described. How to approach zonular weakness in microspherophakia is also discussed. The chapter ends by offering pearls on pediatric cataract surgery in eyes with prior glaucoma or cornea surgery, such as the use of low-flow settings on the vitrector.

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Notes

  1. 1.

    The classification of small eyes is confusing [9]. Simple microphthalmia is defined as having a short axial length less than 2 standard deviations below the normal for age, typically 17.8 mm in infants and 20.5 mm in adults with no other malformations. Complex microphthalmia indicates the presence of microphthalmia with additional malformations such as iris coloboma, chorioretinal coloboma, persistent fetal vasculature, or retinal dysplasia. Relative anterior microphthalmos is a normal length eye with an abnormally small anterior segment [9, 10]. Microcornea is defined as a corneal diameter of less than 9 mm in an infant and 10 mm in an adult. Microcornea may be a feature of microphthalmic eyes, nanophthalmic eyes, and sometimes even long, myopic eyes [11]. Nanophthalmia is a short eye with a small anterior segment and thick sclera and choroid; there is no agreed-on axial length cutoff for nanophthalmic eyes [10].

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Authors and Affiliations

  1. Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Benjamin Jastrzembski & Asim Ali

  2. Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Benjamin Jastrzembski

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  1. Benjamin Jastrzembski
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  2. Asim Ali
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Correspondence to Asim Ali .

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Editors and Affiliations

  1. Department of Ophthalmology, Johns Hopkins Hospital Wilmer Eye Institute, Baltimore, MD, USA

    Courtney L. Kraus

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Jastrzembski, B., Ali, A. (2020). Pediatric Cataract Surgery in the Abnormal Anterior Segment. In: Kraus, C. (eds) Pediatric Cataract Surgery and IOL Implantation. Springer, Cham. https://doi.org/10.1007/978-3-030-38938-3_23

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  • DOI: https://doi.org/10.1007/978-3-030-38938-3_23

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-38937-6

  • Online ISBN: 978-3-030-38938-3

  • eBook Packages: MedicineMedicine (R0)

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