Day 1 :
Altino Ventura Foundation
Keynote: Outcomes of congenital cataract surgery with intra-operative intra-cameral triamcinolone injection versus postoperative oral prednisolone
Time : 09:00 AM
Marcelo C Ventura was graduated from the Medical School of the University of Pernambuco, in Recife, Brazil and completed his Residency training at the Santa Casa de Misericórdiain São Paulo, Brazil. He has completed his Fellowship training in Retina and Cataract Surgery at the University of Puerto Rico. He has also obtained his Master and PhD degrees at the Federal University of São Paulo. He is the Co-Founder and CEO of the Altino Ventura Foundation and Co-Founder and Member of the Board of Directors of the HOPE Hospital, both in Recife, Brazil. He is also the past President of the Latin American Society of Cataract and Refractive Surgeons and of the Brazilian Cataract Society.
Congenital cataract is an important cause of reversible blindness in childhood. Early diagnosis and surgery, adequate refractive error correction and aggressive amblyopia management improve these patients’ visual prognosis. However, early cataract surgery is associated with greater risk of complications, possibly due to the enhanced inflammatory response and the more reactive vitreous face in children. The use of corticosteroids for modulating postoperative ocular inflammation was established decades ago. Topical and systemic corticosteroid administration results in effective intraocular concentrations. However, they do not maintain long adequate concentrations of the drug in the aqueous humor, which is compensated by frequent doses in the postoperative period. This, in turn, increases the risk of adverse events. Moreover, caregivers do not always adhere to the instructions for administering drugs postoperatively, a scenario favoring complications that may compromise the visual prognosis. In contrast, intraocular injection of corticosteroid delivers an adequate and sustained quantity of the drug to the target tissue. Triamcinolone acetonide is a deposit corticosteroid with low water solubility, which contributes to its prolonged action. It has been increasingly used in ophthalmology as a vitreous dye in children and adults, as well as to modulate intraocular inflammation after phacoemulsification in adults. However, its use is not exempt of risks. Thus, we conducted a series of studies to investigate and compare the use of intracameral triamcinolone at the end of the procedure versus the conventional use of postoperative oral prednisolone for modulating intraocular inflammation in children that undergo congenital cataract surgery younger than 2 years of age.
John A Moran Eye Center-University of Utah
Time : 09:30 AM
Lisa Brothers Arbisser teaches Cataract and Anterior Segment Surgery worldwide and is a Princeton University Graduate. She is an Adjunct Associate Professor at University of Utah Moran Eye Center. She authors, edits and reviews textbook chapters, journal articles and the American Academy online news network, Focal Points and has two regular journal columns. Her Residency at the University of Iowa Hospitals and Clinics prepared her to specialize in refractive and complex cataract surgery, both adult and pediatric. She has been for years on the Best Doctors list nationally, was voted to the top 50 opinion leaders in cataract and refractive surgery by the readership of Cataract and Refractive Surgery Today (CRST) and was chosen as one of the 250 leading innovators in the field of premium IOL implant surgery by the editors of Premier Surgeon. She serves on the Editorial Board of CRST and Eye World and pens a quarterly column for each. She serves on the Cataract Committee for the AAO Online and Education Network and is the Cataract Editor for Focal Points.
For over a decade the state of the art pediatric cataract surgery has required vitrectorrhexis and anterior vitrectomy to avoid opacification of the visual axis. This paper will explain the rationale and methods for planned posterior capsulotomy with posterior optic capture into Berger’s space without vitrectomy in the pediatric eye as originally described as far back as 1991. This paper will contend that advantages include not only a zero rate of visual axis opacity due to proliferation of lens epithelial cells but a quieter eye without lens epithelial cell transformation and metaplasia which cause lens decentration, phimosis and whitening of the anterior capsule. There is potential for reducing the incidence of subsequent congenital cataract glaucoma and retinal tears and detachment which may follow when the trabecular meshwork is not burdened with elements of vitreous and the vitreous base is stabilized by the posterior placement of the lens without violating the posterior segment’s integrity. Additionally the bag and sulcus remains available for secondary refractive implantation later in life. The recent infant aphakia trial’s complications seen with pseudophakia are not unlike complications seen in adult eyes whose surgery is complicated by vitreous loss. The author has 5 years’ experience with this technique with excellent outcomes. Rabbit studies will be underway; an excellent model for pediatric cataract. This paper will describe the literature documenting safety. Surgical methods of accomplishing this goal, even for the low volume surgeon, with modalities not in common use today will be described.