Long Term Outcome Following Cataract Surgery in Pediatric ...

548 AIOC 2010 PROCEEDINGS
AUTHORS’S PROFILE:
Dr. MURALIDHAR RAJAMANI: M.B.B.S (2000), JIPMER, Pondicherry; M.D. (2003), Dr
Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi; F.R.C.S. (Glasgow) (2005);
DNB (2005), National Board of Examinations, New Delhi; MRCO (2006), Royal College of
Ophthalmologists. Presently, Consultant, Pediatric Ophthalmology and adult strabismus,
Aravind Eye Hospital, Madurai, Tamilnadu
Long Term Outcome Following Cataract Surgery in Pediatric
Patients with Posterior Lenticonus
Dr. Muralidhar Rajamani, Dr. Ranjith Kumar Puligada, Dr. Anand,
Dr. Vijayalakshmi P., Dr. Shashikant Shetty
(Presenting Author: Dr. Muralidhar Rajamani)
Posterior lenticonus is characterized by a
posterior ectasia of the posterior capsule. This
can result in myopia, irregular astigmatism and a
progressive cataract. 1 The defect in the posterior
capsule can cause migration of the lens matter
into the vitreous - the fish tail sign. The capsule
being thin has a tendency to give way during
surgery. Modern microsurgical techniques have
minimized the rate of posterior capsular rupture
and vitreous loss permitting implantation of an
IOL in the bag many of these patients with good
visual outcomes. 2
Materials and Methods
Records of patients aged 0-14 years who had
undergone surgery in our institute between the
year Jan 2003-Dec 2006 were reviewed. Only
those patients who had completed at least one
year of follow up were included for the study.
Data regarding the age, sex, laterality, anterior
and posterior segment findings, intraoperative
findings, follow up etc was collected from the
medical records.
All children underwent lens aspiration with IOL
implantation (for children above 2 years) under
general anaesthesia. IOL implantation in younger
children was left to the discretion of the operating
surgeon.The IOL power was calculated using the
modified SRK II formula. For children

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table (Total cataract in these patients precluded
preoperative diagnosis)
Five eyes (26.3%) had posterior capsular rupture
with vitreous loss on table (three had a preexisting
posterior capsular dehiscence with lens
matter in the anterior vitreous). In one a three
piece PMMA IOL was sulcus implanted, the rest
had Acrysof implantation in the bag. At the last
follow up, twelve eyes (63.2%) had visual acuity
of 6/24 or better/good fixation. Five eyes of five
patients required YAG capsulotomy and one
required surgical membranectomy to clear visual
axis opacification –VAO (31.6%). Of these three
patients were less than two years of age at the
time of primary surgery. Amblyopia was noted
to be the primary cause for poor visual gain.
Discussion
Posterior lenticonus is complicated by a relatively
high rate of posterior capsular rupture with
vitreous loss during surgery, but it is usually
1. Tesser RA, Hess DB, Buckley EG. Pediatric
Cataracts and Lens Anomalies. In:. Nelson LB,
Olitsky SE editors Harley’s Pediatric
Ophthalmology 2005, Pennsylvania USA pages
255-284.
2. Mistr SK, Trivedi RH, Wilson ME. Preoperative
considerations and outcomes of primary intraocular
lens implantation in children with posterior polar
and posterior lentiglobus. J AAPOS 2008;12:58-61.
References
possible to implant an IOL in the bag. A study by
Mitr et al, reported a low rate of posterior
capsular rupture. 2 But it must be noted that three
out of five patients in our series had a preexisting
dehiscence of the posterior capsule. Also
the diagnosis was made on the table in three
patients because of total cataract. This has been
reported3 and is of significance as any surgeon
operating a total cataract should be ready for
such an eventuality. Our rate of visual axis
opacification is relatively high compared to the
study of Mitr et al 2 , but only one patient required
a surgical membranectomy. This could also be
because of the lower age of patients in our study.
The typical age of presentation has been noted to
be between three to seven years whereas six of
our patients were younger than two years at the
time of surgery. 4 This is a unique feature noted in
our study. The visual outcomes were fairly good
and is comparable to other studies.
3. Cheng KP, Hiles DA, Biglan AW, Pettapiece MC.
Management of posterior lenticonus. J Pediatr
Ophthalmol Strabismus 1991;28:143–9.
4. Nelson LB, Brown GC, Arentson JJ. Posterior
lentiglobus (lenticonus). In: Nelson LB, Brown GC,
Arentson JJ, eds. Recognizing Patterns of Ocular
Childhood Diseases.Thorofare, NJ: SLACK
Incorporated; 1985:64-64.