PRK and LASEK in children

It is important for surgeons to put the IOL in the bag in children's eyes and to do this securely, surgeons must perform anterior and posterior rhexis, Professor Charlotta Zetterström of the Eye Department at Ullevål University Hospital, Norway, told delegates Saturday.

If you don't have these rhexis compete, she said, you can end up with the eye in the sulcus, leading to inflammation, uveitis, glaucoma and haemorrhages.

Discussing her technique in more detail, Dr Zetterström said that the anterior capsulorrhexis should be round and without tears. “Aiming for a small one, because the anterior is very elastic,” she said. “Followed by a round, well-centered posterior rrhexis without any tears.

“You open the bag with the ophthalmic viscosurgical device and then insert the lens,” she said, adding, “There are many lenses to choose from, I use a hydrophobic acrylic one-piece lens. It's very soft, opens well and is nice in small eyes,” she said.

After-cataract is one of the more serious complications associated with IOL implantation in children Dr Zetterström said.

“Unfortunately Visual Axis Opacification (VAO) is still a problem when anterior and posterior rhexis have been performed. LEC proliferation and VAO is common in young eyes, the cells migrates from the lens-equator. These peripheral cells are impossible to clean mechanically,” she said.

What happens to VAO if you don't implant the lens, she queried. “You will have a lot proliferation in the periphery and you will have fusion of the posterior and anterior capsule, and you will have this Soemmering's ring. But you will have less VAO. The centre of the pupil will be clean.

However if you put in a lens, she said, the LECs will grow on the anterior surface of vitreous or on the posterior surface of the IOL. “And you don't have fusion of the Anterior and posterior capsule, and no Soemmering's ring,” she said. “Unfortunately there is VAO.”

Options to decrease VAO in the future included capture of the lens epithelial cells with a bag-in-the-lens and inhibition of LEC proliferation with anti-metabolites, she said.