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Special technique effectively treats difficult traumatic cataracts in children, with long-lasting results
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BARCELONA — A special technique for treating traumatic cataract in young eyes, shifting the IOL optic behind the posterior capsule, is showing rewarding long-term results, according to a speaker here.
The incidence of traumatic cataract is high among South African children. One of the causes is a local thorn tree, "with thorns as sharp and efficient as a diamond knife," Robert Stegmann, MD, said at a joint symposium of the European Society of Cataract and Refractive Surgeons and the World Congress of Paediatric Ophthalmology and Strabismus.
Although many of these cases present to his clinic days or even weeks after the injury, Dr. Stegmann's technique allows good, long-lasting recovery of vision with no posterior capsule opacification and an extremely low incidence of secondary glaucoma. "Many of these thorn injuries present with linear tears. Instead of doing a circular capsulorrhexis, I just continue with a linear capsulorrhexis," he said. "I use dry aspiration because there might be holes in the posterior capsule and [balanced salt solution] would flood onto the vitreous."
The anterior hyaloid is then separated from the posterior capsule to allow at least 1 mm of free space in which to do a parallel posterior capsulotomy. Finally, the IOL is placed into the bag, and when the haptics are firmly in place, the optic is gently pushed behind the posterior rhexis.
"I started using this method in 1992, and I am now approaching 700 such cases. Any PCO is limited to the peripheral bag, leaving a clear central visual access," he said.
Dr. Stegmann showed the eyes of patients treated 14 and 25 years ago. They achieved and maintained 20/25 visual acuity and the central visual access was still crystal clear.