Pediatric traumatic cataract: maximizing the surgical outcome.


Pediatric traumatic cataract is one of the
major cause of avoidable blindness worldwide. Primary objective of this video is to demonstrate
how we can improvise final visual out come in pediatric traumatic cataracts using various
surgical techniques according to morphology….. There is no standard morphological classification.
Using a large database, we systematically classify the morphology of traumatic cataract cataracts are classified as
total…. white…. membranous….rosette
cataract… Here in this case, loose cortical material
is floating in the anterior chamber together with a ruptured lens capsule Such cataracts
are defined as a white soft cataract. Here we are demonstrating bimaual aspiration
of soft cataract through limbal route . After cortical clean up … foldable IOL is
placed in the bag… Capsular tag were removed … primary posterior capsulotomy and limited anterior vitrectomy is being done using vitrectomy cutter through pars plana route… Here another case of sotf white fluffy cataract
anterior capsule is ruptured… we are doing bimaual cortical aspiration….
Capsular tag is removed… Foldable IOL is implanted in the bag.. If the anterior capsule is significantly disruptedand there is free floating lens matter in the anterior chamber, the surgeon may be justified in primary cataract extraction with or without
IOL implantation. In this case, anterior capsule is significantly
disrupted and there is lens matter is free flaoting in the AC with a lens vitreous admixture….
Instead of using aspirator, judicious use of vitrectomy cutter is mandatory for removing lens -vitreous admixture… because any traction on the vitreous may result in retinal breaks. We tried to implant foldable IOL.. But due to extension of anterior capular tear, IOL couldn’t remain in proper position. anterior vitrectomy was performed through limbal approach & iridocapsular synechiae was cut using vitrectomy cutter. Non -foldable PMMA lens is inserted into sulcus. In our experience, cases with anterior capsular tear the surgical outcome is better with PMMA lens than the foldable lens. In this case, both capsules were fused with
organized matter…and formed a dense membrane. It defined as a membranous cataract.
Here we are demonstrating membranectomy using vitrectomy cutter through limbal appproch…..
After making sclero-corneal tunnel Limited anterior vitrectomy is performed …
Non foldable PMMA lens is inserted and dialled into the sulcus..
A cataract was defined as total when no clear lens matter was observed between the capsule
and nucleus. It is a hard nucleus with good capsular support.
we performed standard procedure of Small incision cataract surgery scelro-corneal tunnel, side
port, capsule staining , Capsulorhexis using forcep, tumbling lens in AC, nucleus delivery,
cortical clean up and inserted PMMA IOL in the bag.
In eyes with an intact anterior capsule and total traumatic cataract, a same-sitting cataract
extraction with IOL implantation should be the best and safest approach for optimal visual
outcome…. We demonstrating few cases of neglected Pediatric
traumatic cataract.. due to delayed presentation Such cases devoloped iridocapsular synechiae,
calcified capsule , dense membrane formation… managemt of such cases are really challenging
task… We are cutting calcified anterior capsule
Cataract is removed through sclera corneal tunnel …
PMMA IOL is interted Primary posterior capsulotomy is performed
through pars plana route… Iridocapsular adhesions break using iris repositor.
capsule and organized matter were fused together and formed dense membrane.
We are performing membranectomy using vitrectomy cutter through the limbal approach and than
Non -foldable PMMA lens is inserted into sulcus. This is a case of absorbed traumatic cataract.
Cataract is removed using vitrectomy cutter.. Posterior capsule is calcified.. so we have
remove the calcified capsule and limited anterior vitrectomy is done…
so to conclude : Morphology of traumatic cataract appeared to be major factor in deciding surgical
technique and associated with final visual outcome. in Pediatric traumatic cataracts proper pre-op
evaluartion is important to find out any other co-ocular morbidities and even than many surprices
may pop up during the surgery… Surgical approach is different for each case
and it is tailored according to pre op findings and intro op scenario.
With proper technique reasonable surgical and visual outcome can be achieved….

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