We have developed a wide range of intraocular lenses offering ophthalmic surgeons a great choice when looking for a solution best suited to their patient’s. We are a Medical Device manufacturer of Intraocular lenses (IOL), Capsular Tension Rings (CTR) and Viscoelastic (Visco). Made in the USA!. Abstract. Several intraocular lens (IOL) materials and types are cur- rently available. Polymethyl methacrylate IOLs used to be the gold standard, but the inability.
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To compare primary implantation of foldable hydrophilic acrylic with polymethylmethacrylate PMMA intraocular lenses IOLs in pediatric cataract surgery in terms of short-term complications and visual outcomes.
This randomized lenas trial included 40 eyes of 31 consecutive pediatric patients aged 1 to 6 years with unilateral or bilateral congenital cataracts undergoing cataract surgery with primary IOL implantation. Primary posterior capsulotomy intraokylar anterior vitrectomy were performed in all eyes.
Patients were followed for at least 1 year.
Intra- and postoperative complications, visual outcomes and refractive errors were compared between the study groups. Mean age lesa 3. Mean follow-up period was No intraoperative complication occurred in any group.
The visual axis remained completely clear and visual outcomes were generally favorable and comparable in the study groups. In pediatric eyes undergoing lensectomy with primary posterior capsulotomy and anterior vitrectomy, hydrophilic acrylic IOLs are comparable to PMMA IOLs in terms of biocompatibility and visual axis clarity, and seem to entail less frequent postoperative complications.
Modern surgical techniques and correction of aphakia with intraocular lens IOL implantation have improved the standard of care for children with cataracts. Hydrophilic foldable IOLs have excellent uveal biocompatibility, are resistant to surface alterations or damage during folding and insertion, and have low potential to damage corneal endothelial cells in case of contact.
Primary posterior capsulotomy and anterior vitrectomy are components of standard pediatric cataract surgery; they eliminate the scaffold for LEC outgrowth and visual axis opacification which seems unrelated to the type of Intraokkular in pediatric eyes. In this trial we compared primary implantation of foldable hydrophilic acrylic with polymethylmethacrylate PMMA IOLs in pediatric eyes in terms of postoperative complications and visual outcomes.
This randomized clinical trial included 40 eyes of 31 consecutive patients aged 1 to 6 years with unilateral or bilateral congenital or developmental cataracts. As it was difficult to establish the age of onset of cataracts with certainty, we did not attempt to distinguish developmental from congenital cataracts.
Exclusion criteria consisted of monocular patients and cataracts associated with ocular abnormalities microphthalmos, microcornea, glaucoma, uveitis, posterior lenticonus, and colobomas or systemic ingraokular, and traumatic or complicated cataracts. Patients were intraokulwr for a minimum period of 12 months. All patients underwent a detailed preoperative evaluation. Ijtraokular attention was paid to the presence of nystagmus, amblyopia or strabismus. When necessary, an examination under general anesthesia was carried lenda.
To increase accuracy, biometric measurements were performed twice in intraokulsr eyes; first with the IOL master Carl Zeiss, Jena, Germanyfollowed by conventional keratometry.
Louis, USA under general anesthesia, preoperatively. The IOL power was adjusted according to patient age Table 1 to achieve postoperative hypermetropia in order to counterbalance the myopic shift in pseudophakic pediatric eyes. All operations were performed under general anesthesia using a standard technique imtraokular one of two experienced anterior segment surgeons MRP and MZ.
A wire lid speculum was inserted. For the PMMA group, a silk superior rectus bridle suture was passed using a tapered needle. The conjunctiva was opened at the limbus llensa 3 clock hours superiorly. A partial thickness scleral groove 6. A blade was used to create a scleral tunnel anteriorly until clear cornea was reached. A microvitreoretinal blade was used to enter the anterior chamber in the center of the tunnel.
A paracentesis site was also fashioned in the tunnel 3 clock hours apart to permit insertion of a gauge butterfly needle for lntraokular of balanced salt solution. For the acrylic IOL group, a temporal clear corneal tunnel incision was made with a 3. In younger patients 1—4 years, 24 eyesanterior capsulotomy was performed using an automated vitrector in circular motion to create a 4—5 mm opening; in older children 16 eyesa bent-tip 27 needle and capsular forceps were used under viscoelastic support to create a 4—5 mm intgaokular continuous curvilinear capsulorrhexis.
Posterior capsulotomy at intrxokular 4 mm in diameter and adequate anterior vitrectomy were performed in all subjects. The foldable acrylic hydrophilic IOL was folded longitudinally with forceps and implanted into the capsular bag. After IOL implantation, viscoelastic material was carefully removed from the anterior chamber and the capsular bag.
The two groups were comparable in terms of age at the time of surgery and follow-up period. Table 2 shows preoperative characteristics of the patients. None of the patients were excluded due to intraoperative complications intraomular were practically nil.
The corresponding figures for cylindrical error were 1. Table 4 summarizes postoperative complications. The inflammation subsided by increasing the frequency of steroid drops and use of mydriatic-cycloplegic eye drops in all 7 eyes. These lenses belong to the family of acrylic-methacrylic polymers similar to Intraokluar which is an acrylic biomaterial made from only one type of monomer. These IOLs show little or no surface alterations or damage from folding because of their soft flexible surface.
They also have low potential to cause damage when touching corneal endothelial cells. However, hydrogel IOLs seem to have lower capsular biocompatibility as compared to other biomaterials, resulting in more LEC outgrowth, anterior capsule contracture and PCO formation following adult cataract surgery.
YAG capsulotomy is necessary, these lenses have a high threshold for laser induced damage. Due to the greater inflammatory response, lensq risk of postoperative complications intrqokular pediatric cataract surgery is higher than adults.
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In very young children, VAO is virtually inevitable and rapidly develops following surgery when the posterior capsule is left intact. Posterior capsule and anterior vitreous management greatly influences visual axis clarity and final visual outcomes in children regardless of IOL material.
Ram and coworkers 17 evaluated the effect of primary posterior capsulotomy with anterior vitrectomy and various IOL materials in 64 eyes of 52 children aged ibtraokular months to 12 years in terms of development of PCO at least 2 years after cataract surgery. Within each group, 16 eyes underwent posterior capsulotomy and vitrectomy however the posterior capsule was left intact in the other 16 eyes. Vasavada et al 18 evaluated VAO and need for a second procedure after Acrysof IOL implantation in eyes of 72 consecutive children with congenital cataracts.
The patients were divided into two groups based on age at the time of surgery; younger than 2 years group 1 and 2 years or more group 2. The latter group was further randomized into 2 subgroups: After a mean follow-up of 2.
The authors concluded that Acrysof IOL implantation with appropriate management of the posterior capsule provided a clear visual axis in pediatric cataract surgery. Ahmadieh et al, 2 in a prospective study on 38 eyes in two equal groups with bilateral developmental and unilateral traumatic cataract, compared two different techniques: The visual axis remained clear in all eyes in both groups during the follow-up period.
In one eye with inadequate capsulotomy smaller than 3 mmpostoperative refraction was difficult, but this did not affect vision. In our study, primary posterior capsulotomy at least 4 mm in diameter and anterior vitrectomy was performed in all cases; mild peripheral PCO was seen in two eyes but VAO did not occur with mean follow-up of Visual axis clarity in our series is comparable to the study by Ram 17group 1 in the study by Vasavada et al 18 who underwent posterior capsulotomy and anterior vitrectomy, as well as with the study by Ahmadieh et al.
Fibrinous uveitis due to increased tissue reactivity is a common lenda during ldnsa early postoperative period in pediatric cataract surgery. The lower incidence of anterior uveitis with hydrophilic IOLs may be attributed to higher biocompatibility, less iris manipulation and trauma during IOL implantation, and good positioning of the IOL within the capsular bag.
Wilson et al 15 noted posterior synechiae in 4. Precipitations on the IOL surface are com-posed of pigment, inflammatory cells, fibrin, blood breakdown products, and other elements; they are often seen during the immediate postoperative period. This complication is much more common in children with dark irides but is usually not visually significant.
In a retrospective study, Wilson et al 15 reported IOL deposits in 6. Deposits have been reported from The incidence of iris capture following pediatric cataract surgery has been reported 8.
In our series, none of the eyes developed IOP rise, glaucomatous changes in the optic disc, clinical cystoid macular edema, retinal detachment or endophthalmitis. The major problem with hydrophilic IOLs is the low capsular biocompatibility, but with appro-priate posterior capsule management performing at least 4 mm posterior capsulotomy and limited anterior vitrectomy, we encountered no case of VAO.
Although pediatric cataracts represent a treatable cause of lifelong visual impairment, good long-term visual outcomes depend on many factors such as age of onset, cataract density, surgical technique, control of postoperative inflammation, and finally continuous refractive correction and visual rehabilitation. Our ldnsa showed that hydrophilic acrylic Intrakkular are as effective intraouklar PMMA IOLs in terms of short- to intermediate-term outcomes following surgery for congenital and developmental cataracts.
National Center for Biotechnology InformationU. J Ophthalmic Vis Res. Author information Article notes Copyright and License information Disclaimer.
Received Nov 13; Accepted Jun 2. This article has been cited by other articles in PMC. Abstract Purpose To compare primary implantation of foldable hydrophilic acrylic with polymethylmethacrylate PMMA intraocular lenses IOLs in pediatric cataract surgery in terms of short-term complications and visual outcomes. Methods This randomized clinical trial included 40 eyes of 31 consecutive pediatric patients aged 1 to 6 years with unilateral or bilateral congenital cataracts undergoing cataract surgery with primary IOL implantation.
Results Mean age was 3. Conclusion In pediatric eyes undergoing lensectomy with primary posterior capsulotomy and anterior vitrectomy, hydrophilic acrylic IOLs are comparable to PMMA IOLs in terms of biocompatibility and visual axis clarity, and seem to entail less frequent postoperative complications.
METHODS This randomized clinical trial included 40 eyes of 31 consecutive patients aged 1 to 6 years with unilateral or bilateral congenital or developmental cataracts.
Table 1 Age-adjusted target hypermetropia. Age yr Target hypermetropia 1—3 5 Diopter 3—5 3.
Open in a separate window. Surgical Technique All operations were performed under general anesthesia using a standard technique by one of two experienced anterior segment surgeons MRP and MZ.
Table 2 Demographic and clinical characteristics of the study groups.
Mature 4 5 Lamellar 6 8 Nuclear 4 3 0. Table 3 Pre- and postoperative visual acuity in the study groups. Lesna, best-corrected visual acuity. Table 4 Postoperative complications in the study groups. Bilateral intraocular lens implantation in the pediatric population. Primary capsulectomy, anterior vitrectomy, lensectomy, and posterior chamber lens implantation in children: Limbal versus pars plana. J Cataract Refract Surg.
Primary intraocular lens implantation in infantile cataract surgery.