Transcript Pediatric Clear Lensectomy for High Myopia
Pediatric Clear Lensectomy for High Myopia
Mounir Bashour, M.D., C.M.
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HPI #1 -- Miss P.
7 y.o. W. F.
PMHx/NKDA/FHx -26.00 + 1.75 x 90 OU Va = 20/100-1 OD/OS Va = 20/70+ OU EOM/Balance/SLE DFE - myopic chorioretinal degeneration Jump to first page
HPI #2 -- Mr. O.
7 y.o. B.M.
PMHx/NKDA/FHx -20.00 + 1.50 x 90 OU Va = 20/80 OD/OS Va = 20/70+ OU EOM/Balance/SLE DFE - myopic chorioretinal degeneration Jump to first page
Treatment Options
Glasses Contact Lenses Refractive Surgery PRK Lasik Clear Lensectomy --> pseudophakia vs aphakia Other Jump to first page
Risks
Intraoperative expulsive choroidal hemorrhage Early Post-Op endophthalmitis corneal decompensation persistent uveitis vitreous hemorrhage Late PVD/Retinal Detachment Aphakic Glaucoma Jump to first page
Arguments For
Lensectomy common pediatric procedure with high success rate Better Vision than with glasses Aphakic Glaucoma Not Likely RD same as in pediatric cataract?
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Arguments Against
Invasive Procedure -- Risks as discussed before Non-invasive methods available Jump to first page
Clear Lensectomy as an Adult Refractive Procedure
Controversial Jump to first page
What Now?
Surgery or not?
Retinal Prophylaxis or not?
PCIOL or not?
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Pediatric Aphakia References
Wheeler DT, Mullaney PB, Awad A, al-Mesfer S, al-Nahdi T, Zwaan J. Pediatric IOL implantation: the KKESH experience [see comments]. J.Pediatr.Ophthalmol.Strabismus. 1997;34:341-6.
Ainsworth JR, Cohen S, Levin AV, Rootman DS. Pediatric cataract management with variations in surgical technique and aphakic optical correction. Ophthalmology. 1997;104:1096-101.
Basti S, Ravishankar U, Gupta S. Results of a prospective evaluation of three methods of management of pediatric cataracts. Ophthalmology. 1996;103:713-20.
Egbert JE, Wright MM, Dahlhauser KF, Keithahn MA, Letson RD, Summers CG. A prospective study of ocular hypertension and glaucoma after pediatric cataract surgery. Ophthalmology. 1995;102:1098-101.
Walton DS. Pediatric aphakic glaucoma: a study of 65 patients. Trans.Am.Ophthalmol.Soc. 1995;93:403-13; discussion 413-20:403-13.
Sinskey RM, Stoppel JO, Amin PA. Ocular axial length changes in a pediatric patient with aphakia and pseudophakia. J.Cataract.Refract.Surg. 1993;19:787-8.
Parks MM, Johnson DA, Reed GW. Long-term visual results and complications in children with aphakia. A function of cataract type. Ophthalmology. 1993;100:826-40.
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Lensectomy References
Batman C, Cekic O. Clear lensectomy and implantation of IOL for high myopia [letter; comment]. Ophthalmology. 1998;105:944-5.
Colin J, Robinet A. Clear lensectomy and implantation of a low-power posterior chamber intraocular lens for correction of high myopia: a four year follow-up [see comments]. Ophthalmology. 1997;104:73-7.
Lambert SR, Fernandes A, Grossniklaus H, Drews-Botsch C, Eggers H, Boothe RG. Neonatal lensectomy and intraocular lens implantation: effects in rhesus monkeys. Invest.Ophthalmol.Vis.Sci. 1995;36:300-10.
Balyeat HD. PVD after clear lensectomy for myopia [letter; comment]. Ophthalmology. 1994;101:975-6.
Colin J, Robinet A. Clear lensectomy and implantation of low-power posterior chamber intraocular lens for the correction of high myopia [see comments]. Ophthalmology. 1994;101:107-12.
Colin J, Robinet A. Retinal detachment after clear lens extraction in 41 eyes with high axial myopia [letter; comment]. Retina. 1997;17:78-9.
Javitt JC. Clear-lens extraction for high myopia. Is this an idea whose time has come? [editorial; comment]. Arch.Ophthalmol. 1994;112:321-3.
Verzella F. Refractive microsurgery of the lens in high myopia. Refract.Corneal.Surg. 1990;6:273-5.
Obstbaum SA. Clear lens extraction for high myopia and high hyperopia [editorial; comment] [see comments]. J.Cataract.Refract.Surg. 1994;20:271 Kirn TF. Ophthalmologic debate: is it reasonable to remove a healthy lens to improve vision? [news]. JAMA. 1987;257:2005 Koraszewska-Matuszewska B, Forminska-Kapuscikowa M, Samochowiec-Donocikowa E, Duraj J. [Surgical treatment of high myopia in children]. Klin.Oczna. 1986;88:60-1.
Goldberg MF. Clear lens extraction for axial myopia. An appraisal. Ophthalmology. 1987;94:571-82.
Wichmann W. Correction of high myopia by implantation of minus-power intraocular lenses in phakic eyes [letter]. J.Refract.Surg. 1996;12:672 3.
Balyeat HD, Parke DW, Wilkinson CP. Should we consider clear lens extraction for routine refractive surgery? [letter; comment]. Refract.Corneal.Surg. 1993;9:226-7.
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