Konjenital Kataraktlı Olgularımızda Cerrahi Tedavi ve Takip Sonuçlarımız

Yıl 2023, Cilt: 5 Sayı: 3, 131 - 137, 10.10.2023

Metin Uçar Orhan Baykal

https://doi.org/10.52827/hititmedj.1212429

Öz

Amaç: Konjenital katarakt tanısı almış ve klinik takibimizde olan hastaların cerrahi tedavi ve takip sonuçlarını incelemektir.
Gereç ve Yöntem: Bu çalışmada konjenital katarakt tanısı konularak, ön kesintisiz kürvilineer kapsüloreksis (ÖKKK), fakoaspirasyon, arka kesintisiz kürvilineer kapsüloreksis (AKKK), anterior vitrektomi operasyonu yapılmış, afakik takipte olan veya siliyer sulkusa göz içi lensi (GİL) implantasyonu uygulanmış, ameliyat tarihinde yaşları 0- 34 yıl arasında olan, 50 hastanın 84 gözü çalışma kapsamında değerlendirilmiştir.
Bulgular: Takip süreleri ortalama 30.9±23 ay olarak tespit edildi. 16 göz ortalama 33 ay takip edildikten sonra, ortalama 45. Ayda, 57 göze ise ilk operasyonda siliyer sulkusa GİL uygulaması yapıldı. Takip süresince 7 gözde sekonder glokom, 9 gözde GİL dislokasyonu, 17 gözde pupilla düzensizliği ve irisde lokalize iris atrofileri, 5 gözde ön vitreusta membran geliştiği görüldü. Hastaların preoperatif en iyi düzeltilmiş görme keskinliği(EİDGK) 0.08±0.02(P+P+ veya el hareketleri seviyesi (EHS)- 5 metreden parmak sayma (mps)), postoperatif EİDGK 0.4±0.3 tespit edilmiş olup, istatiksel olarak anlamlıydı( P<0.001).Afakik takibi yapılıp sekonder GİL uygulanan 16 hastanın son kontrol muayenelerindeki görme düzeyleri ortalama 0.2 seviyesinde tespit edildi.
Sonuç: Konjenital kataraktın cerrahi tedavisinde, ÖKKK, fakoaspirasyon, AKKK, Anterior Vitrektomi ve/veya Siliyer Sulkusa GİL İmplantasyonu, arka kapsül kesafetini önlemede ve cerrahiye ait komplikasyonların minimalize edilmesinde etkili, güvenilir, iyi görsel sonuçlar veren tekniktir.

Anahtar Kelimeler

Afakik tashih, anterior vitrektomi, arka kesintisiz kürvilineer kapsüloreksis, göz içi lens implantasyonu, konjenital katarakt

Proje Numarası

none to declare

Surgical Treatment And Follow-Up Results In Our Congenital Cataract Cases

Öz

Objective: Our aim to examine the results of surgical treatment and follow-up of patients diagnosed with congenital cataract and who are under our clinical follow-up.
Material and Method: In this study, a diagnosis of congenital cataract was made, anterior continuous curvilinear capsulorhexis, phacoaspiration,posterior continuous curvilinear capsulorhexis, anterior vitrectomy operation and/or intraocular lens implantation was performed in the ciliary sulcus, apakic follow-up was performed, and patients aged 0-34 years at the time of surgery. 84 eyes of 50 patients were evaluated
Results: The mean follow-up period was 30.9±23months.After an average of 33 months of follow-up in 16 eyes, intraocular lens was applied to the ciliary sulcus in 57 eyes at an average of 45 months. During the follow-up period, secondary glaucoma was observed in 7eyes, intraocular lens dislocation in 9 eyes, pupillary irregularity and localized iris atrophy in 17 eyes,and anterior vitreous membrane development in 5 eyes. The preoperative best corrected visual acuity of the patients was 0.08±0.02 (P+P+ or hand motion-5m counting finger), and the postoperative best corrected visual acuity was 0.4±0.3, which was statistically significant(P<0.001).Apakic follow-up and secondary intraocular lens were applied to 16 patients, with an average visual acuity of 0.2.
Conclusion: In the surgical treatment of congenital cataracts, anterior continuous curvilinear capsulorhexis, phacoaspiration, posterior continuous curvilinear capsulorhexis, anterior vitrectomyand/or intraocular lens implantation into the ciliary sulcus is an effective, reliable, and good visual technique in preventing posterior capsule occlusion and minimizing surgical complications.

Anahtar Kelimeler

Afakik tashih, anterior vitrektomi, arka kesintisiz kürvilineer kapsüloreksis, göz içi lens implantasyonu, konjenital katarakt

Destekleyen Kurum

none to declare

Proje Numarası

none to declare

Teşekkür

none to declare

Kaynakça

• Potter WS. Pediatric cataracts. Pediatr Clin North Am 1993;40(4):841-853.
• Zhao QH, Zhao YE. Commentary review: challenges of intraocular lens implantation for congenital cataract infants. Int J Ophthalmol 2021;14(6):923-930.
• Jody N, Santana M, Rudell J. Pediatric cataract surgery: considerations and updates in diagnosis and management. Curr Opin Ophthalmol 2023;34(1):58-63.
• Vasavada AR,Nihalani BR. Pediatric cataract surgery. Current Opinion in Ophyalmology 2006;17(1): 54-61.
• Buckley EG, Klombers LA, Seaber JH, Scalise-Gordy A, Minzter R.. Management of the posterior capsule during pediatric intraocular lens implantation: Am J Ophthalmol 1993;115(6):722-728.
• Vasavada A, Desai J. Primary posterior capsulorhexis with and without anterior vitrectomy in congenital cataracts: J Cataract Refract Surg 1997;23(1):645-651.
• Self JE, Taylor R, Solebo AL, et al. Cataract management in children: a review of the literature and current practice across five large UK centres. Eye (Lond) 2020;34(12):2197-2218.
• Bremond-Gignac D, Daruich A, Robert MP, Valleix S. Recent developments in the management of congenital cataract. Ann Transl Med 2020 Nov;8(22):1545.
• Mohammadpour M, Shaabani A, Sahraian A,et al. Updates on managements of pediatric cataract. J Curr Ophthalmol 2018;31(2):118-126.
• Zhang JS, Wang JD, Yusufu M, et al. The effect of retaining intact posterior capsule in congenital cataract surgery in children aged 4-8 years. BMC Ophthalmol 2021;21(1):332.
• Guo S, Wagner RS, Caputo A. Management of the anterior and posterior lens capsules and vitreus in pediatric cataract surgery. J Pediatr Ophthalmol Strabismus 2004;41(6):330-337.
• Jensen AA, Basti S, Greenwald MJ, Mets MB. When may the posterior capsule be preserved in pediatric intraocular lens surgery? Ophthalmology 2002;109(2):324-327.
• Luo Y, Lu Y, Lu G, Wang M. Primary posterior capsulorhexis with anterior vitrectomy in preventing posteriorcapsule opacification in pediatric cataract microsurgery. Microsurgery 2008;28(2):113-116.
• Ram J, Brar GS, Kaushik S, Gupta A, Gupta A. Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery. J Cataract Refract Surg 2003;29(8):1579-1584.
• Er H, Doganay S, Evereklioglu C, Erten A, Cumurcu T, Bayramlar H. Retrospective comparison of surgical techniques to prevent secondary opacification in pediatriccataracts. J Pediatr Ophthalmol Strabismus 2000;37(5):294-298.
• Chen J, Chen Y, Zhong Y, Li J. Comparison of visual acuity and complications between primary IOL implantation and aphakia in patients with congenital cataract younger than 2 years: a meta-analysis . J Cataract Refract Surg 2020;46(3):465-473.
• Zetteström C, Kugelberg M. Pediatric cataract surgery. Acta ophthalmol Scand 2007;85(7):698- 710.
• Simons BD, Siatkowski RM, Schiffman JC, Flynn JT, Capo H, Munoz M. Surgical technique, visual outcome, and complications of pediatric intraocular lens implantation. J Pediatr Ophthalmol Strabismus 1999;36(3):118-124.
• Vasavada AR, Raj SM, Nihalani B. Rate of axial growh following congenital cataract surgery. Am J ophthalmol 2004;138(6):915-924.
• Tromans C, Haigh PM, Biswas S, Lloyd IC. Accuracy of intraocular lens power calculation in paediatric cataract surgery. Br J Ophthalmol 2001;85(8):939-941.
• Prost ME. İOL calculations in cataract operations in children. Klin Oczna 2004;106(4-5):691-694.
• Vishwanath M, Cheong-Leen R, Taylor D, Russell-Eggitt I, Rahi J. Is early surgery for congenital cataract a risk factor for glaucoma? Br J Ophthalmol 2004;88(7):905-910.
• Lundvall A, Kugelberg U. Outcame after treatment of congenital bilateral cataract. Acta Ophthalmol Scand 2002;80(6):593-597.
• Arıtürk N, Öge Y, Erkan D, Süllü Y, Türkoğlu S. Konjenital katarakt cerrahisi sonrası sekonder glokom olguları. MN Oftalmoloji 1997;4(5):295-299.
• Asrani GS, Wilensky JT. Glaucoma after congenital cataract surgery. Ophthalmology 1995;102(6): 863-867.
• Vasavada AR, Trivedi RH, Sing R. Necessity of vitrectomy when optic captureis performed in children older than 5 years. J Cataract refract surg 2001;27(8):1185-1193.
• Zhang S, Wang J, Li Y, Liu Y, He L, Xia X. The role of primary intraocular lens implantation in the risk of secondary glaucoma following congenital cataract surgery: A systematic review and meta-analysis. PLoS One 2019;14(4):e0214684.
• Singh R, Barker L, Chen SI, Shah A, Long V, Dahlmann-Noor A. Surgical interventions for bilateral congenital cataract in children aged two years and under. Cochrane Database Syst Rev. 2022;9(9):CD003171.
• Lorenz B, Wörle J, Friedl N, Boergen KP. Monocular and binocular fuctional result in case of contact lens corrected infant aphakia. İn Cotlier E, Lambert S, Taylor D eds. Congenital cataracts. Austin, Texas: RG Landes, 1994:151-163.
• Onal M, Ozdek S, Koksal M, Hasanreisoğlu B. Pars plana lensectomy with dauble capsule supported intraoculer lens implantation in children. J Cataract Refract surg 2000;26(4):486-490.