1/15. Electric cataract: a case report and review of the literature.A case of electrically induced cataract in both eyes in a 12-year-old boy, after a high-voltage electric shock, is reported. He sustained skin burns on the neck, chest, abdomen, and inner left arm. The cataract developed first in the left eye and later on in the right eye. The child regained normal vision in both eyes after cataract extraction and aphakic correction with spectacles. The need for awareness of the possibility of this complication and screening of all cases of electrical injuries is stressed. The majority of cases respond well to surgery, but final visual acuity will depend on the other ocular damage due to electrical current. The clinical features and pathogenesis of this condition are briefly reviewed.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/15. In-the-bag secondary intraocular lens implantation in children.BACKGROUND: Surgery for congenital cataracts in early infancy usually includes a primary posterior capsulectomy and an anterior vitrectomy. Initially, most of these infants have aphakia after surgery. Over time, remaining equatorial lens epithelial cells produce new cortical fibers, resulting in a ring of cortex trapped between the lens equator and the fused anterior and posterior capsulectomy edges. A potential space is maintained between the anterior and posterior capsular leaflets. We describe a technique for placing a secondary intraocular lens (IOL) within the capsular bag. patients AND methods: Eight children, ranging in age from 11 months to 14 years, who originally had aphakia after cataract extraction were operated on with the intent to reopen the capsular bag and place an IOL in the bag. RESULTS: Secondary in-the-bag IOL implantation was successfully completed in 7 of 8 children. This was accomplished by reopening the capsular bag 360 degrees at the edge of the fused anterior and posterior capsulectomy remnants, using the previously published vitrectorhexis technique. Residual cortical material was aspirated, and an IOL was placed within the capsular bag. In 1 child, aged 14 years, the capsular bag was reopened, but the lens was placed in the ciliary sulcus because the new anterior capsule edge could not be visualized for 360 degrees . CONCLUSION: Placement of secondary IOLs within the capsular bag can be accomplished successfully for selected patients in the pediatric population. Surgeons operating on infantile cataracts without primary IOL placement can facilitate capsular IOL sequestration later by limiting the anterior and posterior capsulectomy to 4 to 5 mm and performing a generous anterior vitrectomy to help prevent secondary closure of the smaller capsulectomy.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/15. Recurrent hyphema in an aphakic child: Swan syndrome.In 1973, Swan described 3 patients who developed hyphema months to years after uncomplicated cataract surgery. He noted focal vascularization from an ingrowth of episcleral vessels at the cataract wound site, resulting in recurrent intraocular bleeding. Swan syndrome has been reported following intracapsular cataract extraction, extracapsular cataract extraction (including clear corneal incisions), iridocyclectomy, and glaucoma filtering procedures. patients typically present with sudden painless blurred vision, often upon awakening, which may or may not be preceded by physical strain or trauma. Other patients are asymptomatic and diagnosed with hyphema or anterior chamber red blood cells on routine examination. The hyphema often resolve spontaneously, making later diagnosis difficult. Gonioscopic visualization of the abnormal wound vessels is necessary for diagnosis. Without active bleeding, however, the fibrovascular tuft may be easily overlooked. We report a case of Swan syndrome in a 16-month-old boy after cataract extraction was performed. To our knowledge, Swan syndrome has not been reported in the pediatric population. Children represent a significant proportion of patients undergoing anterior segment surgery and Swan syndrome should be considered in the differential diagnosis of hyphema in this population.- - - - - - - - - - ranking = 3keywords = extraction (Clic here for more details about this article) |
4/15. Clinical and pathologic findings of aphakic peripheral corneal edema: Brown-McLean syndrome.Twenty-two patients (36 eyes) are reported with Brown-McLean syndrome, which consists of peripheral corneal edema associated with peripheral endothelial pigment deposits, usually after intracapsular cataract extraction. This group, the largest reported to date, had a spectrum of corneal alterations, those at the more severe end of the spectrum being both progressive and symptomatic. Some patients required medical and surgical treatment, including keratoplasty. Four corneas (two obtained surgically, two postmortem) were examined by light and electron microscopy (EM). Centrally, the corneas were relatively normal, but peripherally there were disintegrated endothelial cells with an abnormal posterior collagenous layer of Descemet's membrane. Scanning EM showed a somewhat distinct junction between the normal central endothelium and the diseased peripheral endothelium.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/15. The correction of unilateral aphakia in children treated for orbital rhabdomyosarcoma.The survival rate of children with localized orbital rhabdomyosarcoma is now greater than 90% 3 years after diagnosis as a result of advances in radiation and chemotherapy. Ninety percent of these children develop cataracts within 1 to 4 years after the completion of radiotherapy. The correction of aphakia in these children is complicated by the concurrent keratoconjunctivitis and dryness associated with radiotherapy. Three patients with a diagnosis of orbital rhabdomyosarcoma underwent treatment for uniocular cataract. Two of the patients were unable to use extended wear contact lenses. Both underwent epikeratophakia with poor results. One patient who had clinically significant ocular drying prior to cataract extraction underwent successful implantation of an intraocular lens as a primary procedure, with excellent visual results. Clinicians should be aware of the difficulties associated with contact lens wear and epikeratophakia tissue lenses in children who have had high doses of radiation for orbital rhabdomyosarcoma. Such patients are probably best served by primary intraocular lens implantation or by preservation of the posterior capsule at the time of cataract extraction to allow secondary lens implantation if contact lens wear is unsuccessful.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
6/15. Optic disc edema with aphakic cystoid maculopathy masquerading as ischemic optic neuropathy.Two patients with visual loss after cataract extraction were found to have prominent pallid optic disc edema, peripapillary hemorrhage, and cystoid maculopathy. A diagnosis of anterior ischemic optic neuropathy, with coincidental aphakic cystoid macular edema, was initially considered. The clinical course, however, favored a diagnosis of visual loss secondary to maculopathy. In both cases, fluorescein angiography disclosed leakage of fluorescein dye from macula, optic disc, and peripapillary foci. fluorescein angiography and stereo color photographs of 51 patients with aphakic cystoid maculopathy were reviewed to determine the incidence of optic disc edema. Although optic disc swelling was rarely recognized on fundus photography, optic disc hyperfluorescence was observed in 75% of cases.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/15. Epithelialization of the anterior chamber: clinical investigation with the specular microscope.Four patients, each of whom had had an uncomplicated cataract extraction, were examined because of an apparent epithelialization of the anterior chamber. In each instance, the diagnosis was later verified histopathologically. The involved eye was photographed with the clinical specular microscope and the endothelial photomicrographs were analyzed. It was noted that considerable endothelial cell loss had occurred, as evidence by the larger size of the remaining cells. endothelial cells were present but they were grossly abnormal well below the demarcation line visible with the slit-lamp biomicroscope. These in vivo observations support the thesis that damage to the corneal endothelium is a necessary factor for epithelial invasion of the anterior chamber.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/15. Extended-wear aphakic soft contact lenses after penetrating keratoplasty.Seven patients undergoing aphakic keratoplasty or combined keratoplasty and cataract extraction were fitted with a single type of high-water-content, extended-wear, aphakic soft contact lens (Permalens). Six patients were fitted early after keratoplasty, ie, before the removal of the sutures and while they were still receiving corticosteroid drops (1% prednisolone acetate). The patients were followed up at close intervals with high-magnification serial corneal photography. Complications of extended wear included superficial neovascularization, punctate epithelial keratitis, and variable visual acuity. Our results suggest that although extended-wear aphakic soft contact lenses may be an acceptance form of visual rehabilitation in selected patients who undergo transplantation, they are frequently problematic. In addition, fitting of these lenses should be withheld until after the removal of the sutures, and patients should be followed up at closer intervals than the patients with extended-wear aphakic soft contact lenses who have not undergone keratoplasty.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
9/15. Delayed onset of aphakic cystoid macula edema.Cystoid macula edema occurred in both eyes of two patients three years after routine intracapsular cataract extraction. Vitreous adhesion to the cataract wound was noted in all four eyes within eight weeks of surgery. The relatively young age and good health of both patients may explain why their perifoveal capillaries remained competent so long after surgery.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
10/15. A histopathologic study of bilateral aphakia with a unilateral intraocular lens in a child.A 7-year-old boy who had had electrically induced cataracts since he was 6 months old underwent a lens extraction by phacoemulsification in his right eye. He later refused to wear a contact lens. When the boy was 10 year old, the lens of his left eye was removed by phacoemulsification and an intraocular lens was implanted. The intraocular lens functioned well and was tolerated by the boy until he died in an automobile accident at the age of 16 years. A histopathologic study of the eyes, which were obtained post mortem, showed a decreased corneal endothelial cell population, mild focal atrophy of iris structures, and mild lymphocytic infiltration in the implanted eye. Vitreous liquefaction and epiretinal membrane formation occurred in both eyes.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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