This is a cataract extraction in a 3-year-old child who presented with bilateral cataracts and the cataract in the right eye was removed. The lens was aspirated and an IOL was implanted in the capsular bag. Both anterior and Posterior capsulotomies were performed. The side port incisions were hydrated and the scleral wound was closed using a suture.
Surgery Location: on-board the Orbis Flying Eye Hospital, Ulaanbaatar, Mongolia
Surgeon: Dr. Jonathan Song, University of Southern California, USA
This child is a three-year-old child who was found to have cataracts in both eyes. He has a hydrogel lens on the right side and left side he has early cortical lamellar changes. So, in this eye, we’re going to go ahead and remove the cataract. So, I always start with the scleral incision first before we go inside the eye. We are going to put in a little bit of neosynephrine to open up the pupil a little bit.
For staining we can use air bubble or not, I don’t use air bubble. Here I’m going to put little Healan. Remember, in a child when their lens is hydrated like this, the cortical material comes out very quickly. So, if we tried to tear this much harder, so we are going to do the capsulotomy with a vitrector, instead of tearing this. Anterior chamber in the child will collapse quite easily. So, this is the probably the easiest way to do anterior capsulotomy This capsule is very elastic. So, you’re starting to run already, I am going to release this tension right here.
If you see this running, I release the tension there or release the tension here. Okay, so now I have the anterior opening. So, I am going to kick it off. So, I kicked off my vitrector. Now I am using IA to remove the lens, so you can suck out the whole lens. Children lenses are very soft, you don’t need phaco, just turn it to where the cortical material is and help it along. If you get stuck, you just help it push it into the port.
I can control the IA and remove the cortical material now. I’ a going to release this tension a little bit here. See how you can make this capsulorhexis very circular. You remove as much as Cortex as possible If you can. I can switch hands and do the other side. I can release a tension here too. So, it doesn’t run.
Then remove the cortex from this side. That looks pretty good. All right. Okay, so now we have the lens out I am going to blow up the bag.
And since the bag is intact, we are going to put in a single piece acrylic lens. The way to maneuver these lenses is, to just rotate it on the body with the sinskey down.
This decision is much smaller, so I am just going to put a single suture here. I always suture my sclera close, so I use a nylon because it’s going to be buried, there’s no chance that it’s going to rub out, so I don’t need to remove this stitch later.
So I’m behind the lens now, I am going to do a posterior capsulotomy. The pupil is so small here so it’s harder. But here I am at the back part now. Okay, then turn upside down, then cut the posterior capsule this way. I have a posterior capsule opening now, so I can enlarge to whatever size I want. As a pediatric ophthalmologist, I like about three to four millimeters.
These capsules contract down. Okay, so that’s a nice opening. Okay, then once you’re done with that, we will do a core vitrectomy. Because you want to break the anterior hyaloid. So, the cells don’t go in the back. Okay, so I did a nice core, then I just come in the front. And I use my irrigation and put the lens back.
And so now you have an anterior capsulotomy and the posterior capsulotomy, it’s all set. And I am going to take all the viscoelastic here, you’ll see what happens. See if I come out, see how everything collapses, there is no chamber anymore. I’ll see if I can hydrate my wound, if not I will suture it.
Here’s the miostat. So, it looks like the wound is holding very nicely. So, this is a great way because now I have the scleral wound covered. So, I don’t have to worry about suture removal at all on this child. I am going to use a 8-0 vicryl to close the conjunctiva. And then even if the child runs around, not a big deal here because everything’s covered. So that will heal very nicely. And I will do my subconjunctival injection, antibiotics, and steroids. And the chamber is good, pressure is good. We’re good. All right. Thank you very much.
September 7, 2018