Cataract surgery in children using the BIL technique
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1 Cataract surgery in children using the BIL technique Tassignon Marie-José, MD, PhD, Febo Dept. of Ophthalmology Antwerp University Hospital, Belgium, Disclosures: intellectual property in the BIL and ring caliper licensed to Morcher, Germany ASCRS The bag-in-the-lens: aiming at preventing PCO US patent: 6,027,531 - PCT : licensed to Morcher, Germany 1
2 Primary posterior capsulorhexis (PPCCC) Posterior capsulorhexis: In Adults: well developed Berger s space (anatomical variations) easy to perform posterior capsulorhexis (more rigid capsule) What is known about the Vitreolenticular interface Berger s space: Embryology: formation between 3 th and 8 th month of gestation virtual space between central part of the posterior capsule and the anterior hyaloid membrane Vitreolenticular interface 2
3 Anterior vitreous face Vitreous: Origin: surface ectoderm (lens), neuroectoderm (retina), mesoderm (vascular endothelium) 1th month: A. Hyaloidea / Tunica vasculosa lentis posterior / Primary Vitreous 2th month: Secondary vitreous 3th month: Marginal bundle of Druault / Ligament of Wieger 4th month: Cloquet s Canal / Berger s space / anterior hyaloid membrane Function: - structural stability of the globe / shock absorbing (eye movement and trauma) - metabolic function (lens clarity and retinal function) - oxigen gradient / antioxidant / Composition: collagen type II (>75%) (+ coll.v/xi, coll.ix, hyaluronan, versican, Fibrillins, Opticin, Vit1, Glycoprot, antioxids.,..) Posterior lens capsule Posterior lens capsule: Origin: Basement membrane of the lens (4µ in thickness) / Surface ectoderm origin Function: - reservoir of growth factors (FGF1&2, HGF, PDGF, VEGF) influencing lens cell proliferation, migration and differentiation Composition: laminin and type IV collagen (+ entactin/nidogen, perlecan, collagen XVIII, collagen XV and agrin) 3
4 Video 1: easy paediatric case Video 2: bridges between anterior hyaloid /posterior capsule 4
5 Video 3: posterior capsule plaque without capsule defect Video 4: posterior capsule plaque with capsule defect 5
6 Video 5: anterior persistant foetal vasculature Videoregistration: cataract surgery in children Surgeries: - 46 eyes of 31 children Mean age: - 42 months (range: months) - 8 children (11 eyes) < 12 months at time of surgery History: - PHPV / PFV: 6 eyes of 6 children Axial length: - range mm Cornea: - range D - steep in young age and PHPV with strong cilliary traction Glaucoma: - 4 eyes of 2 patients Trabeculotomy: 1x before cataract surgery and 1x combined procedure 6
7 Videoregistration: cataract surgery in children Vitreolenticular interface: - 26x easy separation of posterior capsule and anterior hyaloid - 5x difficult separation with anterior hyaloid remained intact - 3x difficult separation with disrupted anterior hyaloid - 8x anterior vitrectomy Posterior capsulorhexis: - possible in all but 1 case Bag-in-the-lens IOL implantation: - possible in all but 1 case (left aphakic) - 1 case with fixation of the BIL at the anterior capsule only - scleral fixation: 4 eyes of 2 patients (Marfan and spherophakia) Results: Bilateral Cataract Cases (15 patients: 30 eyes) Best corrected postoperative visual acuity: BCVA PRE BCVA POST 1 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0, Bilateral cataract patients 7
8 Results: Unilateral cataract cases 16 patients- 16 eyes Best corrected postoperative visual acuity: BCVA PRE BCVA POST 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0, Unilateral cataract patients Postoperative results: one year or more after primary surgery Postoperative refraction: spherical equivalent Number of eyes > -5 > -4 > -3 > -2 > -1 > 0 > 1 > 2 > 3 > 4 > 5 Postoperative spherical equivalent (D) 0 8
9 Posterior lens capsule: Collagen type II AB Collagen Type II antibody: +Fluorescein isothiocyanate labelling positive staining! 9
10 Conclusion: Cataract surgery was performed in 42 consecutive eyes of 31 children. Bag-in-the lens IOL implantation was possible in all except one case. Strong adherences between posterior capsule and anterior hyaloid were found in 16 eyes (38%) requiring viscodissection Only 8 eyes (19%) required anterior vitrectomy (PFV) Collagen type II (vitreous origin) was found in posterior capsule plaques Hypothesis: regression of tunica vasc. lentis/fetal vasculature interferes with post capsule development??? Thank You Acknowledgement: Jan Van Looveren MD (PhD student), Ilse De Veuster MD, Veerle Van Gerwen BaSci, Rudi Leysen Med Photo, 10
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