John A Moran Eye Center-University of Utah
Title: Challenging the standard of care for pediatric cataract surgery
Biography: Lisa Brothers Arbisser
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.