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  • Pediatric Cataract and IOL Surgery: Current Practices and Controversies Dr Vidushi Sharma & Dr Suresh K Pandey SuVi Eye Institute Kota India American Society of Cataract & Refractive Surgery (ASCRS) Instruction Course

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    American Society of Cataract & Refractive Surgery (ASCRS) Instruction Course: Pediatric Cataract and IOL Surgery: Current Practices and Controversies Session: 21-210; Date/Time: April 21, 2013 from 10:00 AM to 11:30 AM Course Faculties: Vidushi Sharma; Suresh K. Pandey; Abhay R Vasavada; Marie José B. Tassignon; Richard J. Fugo; Rupal H. Trivedi; Howard V. Gimbel Course Description: Lecture and video-based course will review current surgical practices of pediatric cataract surgery with emphasis on timing of surgery, IOL power calculation, posterior capsule management, and pearls for managing challenging cases. Controversies such as implantation of IOL in infants and simultaneous bilateral pediatric cataract surgery will be discussed. Educational Objective: Attendee will understand the technical nuances in handling pediatric cataracts, and how to handle challenging situations like infantile cataract, sub-luxated cataract, micro-ophthalmos, posterior lenticonus, traumatic cataract, and cataract with pre-existing posterior capsule defect, etc. SCIENTIFIC PROGRAM: 1. Pediatric Cataract Surgery-Current Practice and Controversy: Introduction and Overview: Dr Vidushi Sharma (2 minutes) 2. Secondary IOL Implantation in Pediatric Cataract Surgery: Dr Howard Gimbel (8 Minutes) 3. Pediatric Cataract Surgery in Challenging Situation: Part I (Traumatic Cataract, Capsular Plaques, Anterior Lenticonus, Pre-existing Posterior Capsule Defect): Dr Vidushi Sharma (15 Minutes) 4. Pediatric Cataract Surgery in Challenging Situation: Part II (Subluxated Cataract/Ectopia Lentis, Micro-ophthalmos, Posterior Lenticonus): Dr Abhay R Vasavada (15 minutes) 5. Posterior Capsule Management & New insights about the anterior vitreo-lenticular interface in children: Dr. Marie José Tassignon (12 minutes) 6. IOL Power Calculation during Pediatric Cataract Surgery: Dr Rupal H. Trivedi (10 minutes) 7. Fugo Blade in Pediatric Cataract Surgery: Dr Richard Fugo (10 Minutes) 8. Managing Infantile Cataracts: Current Trends and Controversies: Dr Suresh K Pandey (10 minutes) 9. Question/Answer and Audience Participation: 8 minutes

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    American Society of Cataract & Refractive Surgery (ASCRS) Instruction Course: Pediatric Cataract and IOL Surgery: Current Practices and Controversies Session: 21-210; Date/Time: April 21, 2013 from 10:00 AM to 11:30 AM Course Faculties: Vidushi Sharma; Suresh K. Pandey; Abhay R Vasavada; Marie José B. Tassignon; Richard J. Fugo; Rupal H. Trivedi; Howard V. Gimbel Course Description: Lecture and video-based course will review current surgical practices of pediatric cataract surgery with emphasis on timing of surgery, IOL power calculation, posterior capsule management, and pearls for managing challenging cases. Controversies such as implantation of IOL in infants and simultaneous bilateral pediatric cataract surgery will be discussed. Educational Objective: Attendee will understand the technical nuances in handling pediatric cataracts, and how to handle challenging situations like infantile cataract, sub-luxated cataract, micro-ophthalmos, posterior lenticonus, traumatic cataract, and cataract with pre-existing posterior capsule defect, etc. SCIENTIFIC PROGRAM: 1. Pediatric Cataract Surgery-Current Practice and Controversy: Introduction and Overview: Dr Vidushi Sharma (2 minutes) 2. Secondary IOL Implantation in Pediatric Cataract Surgery: Dr Howard Gimbel (8 Minutes) 3. Pediatric Cataract Surgery in Challenging Situation: Part I (Traumatic Cataract, Capsular Plaques, Anterior Lenticonus, Pre-existing Posterior Capsule Defect): Dr Vidushi Sharma (15 Minutes) 4. Pediatric Cataract Surgery in Challenging Situation: Part II (Subluxated Cataract/Ectopia Lentis, Micro-ophthalmos, Posterior Lenticonus): Dr Abhay R Vasavada (15 minutes) 5. Posterior Capsule Management & New insights about the anterior vitreo-lenticular interface in children: Dr. Marie José Tassignon (12 minutes) 6. IOL Power Calculation during Pediatric Cataract Surgery: Dr Rupal H. Trivedi (10 minutes) 7. Fugo Blade in Pediatric Cataract Surgery: Dr Richard Fugo (10 Minutes) 8. Managing Infantile Cataracts: Current Trends and Controversies: Dr Suresh K Pandey (10 minutes) 9. Question/Answer and Audience Participation: 8 minutes

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    67 visualizações24 páginas

    Pediatric Cataract and IOL Surgery: Current Practices and Controversies Dr Vidushi Sharma & Dr Suresh K Pandey SuVi Eye Institute Kota India American Society of Cataract & Refractive Surgery (ASCRS) Instruction Course

    Enviado por

    suvieye
    American Society of Cataract & Refractive Surgery (ASCRS) Instruction Course: Pediatric Cataract and IOL Surgery: Current Practices and Controversies Session: 21-210; Date/Time: April 21, 2013 from 10:00 AM to 11:30 AM Course Faculties: Vidushi Sharma; Suresh K. Pandey; Abhay R Vasavada; Marie José B. Tassignon; Richard J. Fugo; Rupal H. Trivedi; Howard V. Gimbel Course Description: Lecture and video-based course will review current surgical practices of pediatric cataract surgery with emphasis on timing of surgery, IOL power calculation, posterior capsule management, and pearls for managing challenging cases. Controversies such as implantation of IOL in infants and simultaneous bilateral pediatric cataract surgery will be discussed. Educational Objective: Attendee will understand the technical nuances in handling pediatric cataracts, and how to handle challenging situations like infantile cataract, sub-luxated cataract, micro-ophthalmos, posterior lenticonus, traumatic cataract, and cataract with pre-existing posterior capsule defect, etc. SCIENTIFIC PROGRAM: 1. Pediatric Cataract Surgery-Current Practice and Controversy: Introduction and Overview: Dr Vidushi Sharma (2 minutes) 2. Secondary IOL Implantation in Pediatric Cataract Surgery: Dr Howard Gimbel (8 Minutes) 3. Pediatric Cataract Surgery in Challenging Situation: Part I (Traumatic Cataract, Capsular Plaques, Anterior Lenticonus, Pre-existing Posterior Capsule Defect): Dr Vidushi Sharma (15 Minutes) 4. Pediatric Cataract Surgery in Challenging Situation: Part II (Subluxated Cataract/Ectopia Lentis, Micro-ophthalmos, Posterior Lenticonus): Dr Abhay R Vasavada (15 minutes) 5. Posterior Capsule Management & New insights about the anterior vitreo-lenticular interface in children: Dr. Marie José Tassignon (12 minutes) 6. IOL Power Calculation during Pediatric Cataract Surgery: Dr Rupal H. Trivedi (10 minutes) 7. Fugo Blade in Pediatric Cataract Surgery: Dr Richard Fugo (10 Minutes) 8. Managing Infantile Cataracts: Current Trends and Controversies: Dr Suresh K Pandey (10 minutes) 9. Question/Answer and Audience Participation: 8 minutes

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    Pediatric Cataract Surgery in Challenging Situations

    Dr. Vidushi Sharma MD (AIIMS, N.DELHI), FRCS (UK)


    Dr Suresh K Pandey MS (PGIMER), ASF (USA) SuVi Eye Institute & Lasik Laser Centre, Kota, RAJ., INDIA Email- suvieye@gmail.com Website: www.suvieye.com NO FINANCIAL INTEREST

    Questions need to be answered


    Is IOL Implantation feasible in infants Current trends in IOL Power Calculation Management of complex pediatric cases (trauma, ectopia lentis, PPCD, ant. & post. lenticonus, capsular plaques, etc) Modalities to achieve clear visual axis and to prevent/delay VAO

    Importance
    Childhood cataracts 1-15 per 10,000 children Birth prevalence of cong. bilateral cataracts
    1-3 per 10,000 children in industrialized countries Likely to be 10 per 10,000 in developing nations

    Impact much more because of increased years of disability

    Issues
    IOL implantation and IOL power calculation

    Capsule management and Anterior Vitreous face


    Postoperative Follow-up

    Challenging Cases
    Traumatic Cataracts Capsular plaques Pre-existing Capsular defects

    Anterior Lenticonus

    Traumatic Cataract
    Blunt or penetrating trauma Young boys predisposed to sports related, home injuries or work related (innocent bystanders)

    Traumatic Cataract

    Traumatic Cataract

    Traumatic Cataracts
    Small, localized, visually insignificant cataracts observe Visually significant cataracts remove at about 4-6 wks following primary repair Thorough evaluation for associated injuries and their surgical M/m specially the capsular bag Radiological Studies for RIOFB

    Capsule Plaques

    Posterior Capsular Plaques


    More common with unilateral cataract Thought to be caused by persistent fetal vasculature even if no obvious hyaloid remnants seen Variable incidence Plaque peeling or posterior capsulorhexis/ vitrectorhexis IOL in the capsular fornices

    Anterior subcapsular plaque


    Incidence of 11.5% More common with white cataracts

    Pre-Existing Posterior Capsular Defects


    Preoperative diagnosis difficult but possible in some cases (fish-tail sign) Convert into posterior rhexis

    Pediatric Toric IOL


    (Anterior lenticonus)
    Often associated with Alports Syndrome Marked thinning of central ant capsule Ant capsule may be fragile or extremely elastic

    Pediatric Supplementary Pseudophakic (Sulcoflex) IOL

    Preservative Free Intracameral Triamcinolone


    Inject 4mg/0.1ml at the end of surgery Stains any vitreous strands Provides postoperative anti-inflammatory action Useful as an adjunct to postoperative topical steroid eyedrops

    Controversies
    IOL Implantation in Infants Simultaneous Bilateral Pediatric Cataract Surgery

    Further Reading

    Audience Participation: Quick Poll


    How many participants are doing pediatric cataract surgery Would you implant an IOL in less than 1 year child with bilateral VS cataract? How would you calculate IOL power? Till what age post. capsulectomy and ant. Vitrectomy is preferred? Are you using intracameral triamcinolone in PCS?

    Pediatric Cataract Surgery in Challenging Situations


    Dr. Vidushi Sharma MD (AIIMS, N.DELHI), FRCS (UK)
    Dr Suresh K Pandey MS (PGIMER), ASF (USA) SuVi Eye Institute & Lasik Laser Centre, Kota, RAJ., INDIA Email- suvieye@gmail.com Website: www.suvieye.com Phone+ 91 9351412449 NO FINANCIAL INTEREST

    Thank You Thank You

    Dr. Vidushi, MD, FRCS www.suvieye.com Email:suvieye@gmail.com

    Image by: Austin Treasure Jansen

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