This is a cataract extraction in a 7-year-old child who presented with amblyopia and cortical cataract in the left eye. Anterior capsulotomy was done and the cataract was aspirated. A single-piece IOL was implanted in the capsular bag as it was intact. Posterior capsulotomy was done and the wounds were hydrated.
Surgery Location: on-board the Orbis Flying Eye Hospital, Ulaanbaatar, Mongolia
Surgeon: Dr. Jonathan Song, University of Southern California, USA
So this is a seven-year-old child who has a sutural as well as cortical cataract. So, he’s developed amblyopia, he’s about 20/200 in each of his eyes. But his left eye, he wasn’t holding at all. So, we decided to proceed with left eye cataract extraction. So, I already did my scleral tunnel, now I am going to do my anterior capsulotomy. So, I control the size of my capsulotomy. With this by six millimetres, so I’m going to take it to the right and turn off my cutter and using it now to remove the lens. This is not like cortex, so you have to stay there and turn the port towards the lens material. This is the nuclei; notice I didn’t use vision blue because I can pretty much see the capsule. Now see my capsulotomy is little small, so I’m going to enlarge a little bit. I took out half of the lens now I’m going to switch hands and take out the other half. If you don’t know how to change the setting to turn on the cutter just go from vitrectomy to IA.
I’d go side to side to loosen up the lens material. So pretty much all mechanics are done, we haven’t used any faecal just mostly irrigation aspiration. If it is stuck, you just touch the tip, and it will go in. Some cortical material I am just stripping off right now. So, this side the capsulotomy all is small also. I take it to the right and, enlarge my capsulotomy here, that’s a pretty good size. All right. So, I’m going to open up the bag with healon. Since the bag is intact, I’m going to put in a single piece lens into the bag. If anything happened to the anterior capsule, then I will put in a sulcus lens and that will be a three-piece lens. I really like in children to really do a scleral tunnel and bury my suture, so I don’t have to worry about them. Even if they rub the eye and run around is not a problem at all. It’s not going to cause astigmatism. So now I’m going to do my posterior capsulotomy. So I have viscoelastic in the front, so I’m going to go behind the lens, posterior capsulotomy, make a hole first. And I see the hole, now got to enlarge it. And once I have the hole, I can turn it up. Now I can control the size of it.
Now I’m going to do a little core, break the anterior hyaloid. I am coming to the front and make the lens go in there. There’s a little run here but the lens is quite stable. So, I’m going to turn around a little bit. We are going to take out the healon from the front. If there’s any vitreous present, I will cut it. I’m going to bring the iris together, hydrate my wounds, see if its closed. If not, I will use 10-0 vicryl to close it. 10-0 vicryl will dissolve by itself so I never had to remove stitches in these children. It’s holding quite nicely. It’s a very quick surgery. So that’s a 8-0 vicryl, I use to close the conjunctiva and bury the knot. Subconjunctival injections and that is the surgery. Any questions? Thank you very much.
September 5, 2018