Pediatric Lens Diseases

Pediatric Lens Diseases

Yizhi Liu Editor Pediatric Lens Diseases

Editor Yizhi Liu State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Guangzhou, Guangdong, China ISBN 978-981-10-2626-3 ISBN 978-981-10-2627-0 (ebook) DOI 10.1007/978-981-10-2627-0 Library of Congress Control Number: 2016960535 Springer Science+Business Media Singapore 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer Nature Singapore Pte Ltd. The registered company address 152 Beach Road, #22-06/08 Gateway East, Singapore 189721, Singapore

Foreword Because of the prevalence of adult cataract and our focus on new surgical and IOL technologies, managing the pediatric patient remains the most neglected subject in the field of cataract surgery. As a group, these cases are the most difficult to manage presenting the triple challenge of diagnosis, surgical removal, and postoperative treatment and rehabilitation. Unfortunately, precious little attention is devoted to this topic in residency training, in print, or on the podium. Pediatric Lens Diseases is a much needed new and comprehensive book on this important subject. It organizes and imparts the collective expertise of the dedicated pediatric cataract team at the Zhongshan Ophthalmic Center (ZOC) of Sun Yat-Sen University in Guangzhou, China. Professor Yizhi Liu is the director of ZOC one of the top academic ophthalmology departments in China and also the chief editor of this book. Professor Liu is widely recognized as one of the top ophthalmic surgeons in the country and has been a global leader in the field of pediatric cataract. As the largest eye hospital in Southeast Asia, ZOC is a tertiary referral center serving an enormous population. After establishing China s first Pediatric Cataract Center in 2011, Professor Liu and his team have now treated more than 2000 pediatric cataract patients. As a result, the ZOC team is one of, if not, the most experienced in the world. This unique clinical database has advanced clinical training and spawned important basic and clinical research. This impressive book on pediatric cataract is the product of this remarkable research, experience, and proficiency. Professor Liu and his colleagues have authored 27 beautifully illustrated chapters that cover every major area of pediatric lens pathology and surgery. This includes some of the best digital images of pediatric cataract and surgery available. This book is particularly well organized because the authors largely come from a single pediatric referral center. Their clinical approach is therefore well integrated and unified. Thanks to the enormous effort that compiling this authoritative resource entailed, ophthalmologists worldwide can now benefit from the collective expertise of one of the best and busiest international pediatric cataract programs. I congratulate Professor Liu and his coauthors on this monumental achievement and for sharing with us the treasure that this valuable book represents. San Francisco, California, USA David F. Chang, MD v

Preface Pediatric lens diseases are the leading cause of blindness in children. They are characterized by poorly understood etiologies and widely varied clinical manifestations. Worse still, current strategies for managing these diseases remain controversial. Simply applying the treatment strategies for adult cataracts and ectopia lentis to pediatric patients without a thorough consideration of anatomical and pathophysiological differences of pediatric eyes may give rise to severe reaction to surgery and frequent complications. This may interfere with visual development and rehabilitation and lay a lifelong disease burden on the children and their family. With the latest advances in developmental biology and pathophysiology of the lens, knowledge of pediatric lens diseases has been advanced. Technical innovations in minimally invasive cataract surgery have greatly improved the treatment outcomes of pediatric lens diseases. In this book, we summarize cutting-edge studies from around the world and emphasize, in particular, the characteristics of ocular structures and visual development in children. A vast amount of valuable clinical data, images, and videos have been collected, and the pathophysiology, perioperative management, surgical techniques and prevention and treatment of complications, as well as visual rehabilitation, are all discussed in great detail. We hope that it will bring more attention and scrutiny to this field that keeps driving the perfection of diagnosis and treatment of these blinding diseases. Medicine is an ever-changing science with new findings and experience in diagnosis and treatment occurring on a daily basis. We have spared no effort to provide information that is comprehensive and generally consistent with the best standards at the time of publication. However, this book might still contain information that is not quite accurate or complete. We encourage and welcome pertinent criticisms and suggestions from every single reader. Guangzhou, Guangdong, China Yizhi Liu, MD, PhD vii

Acknowledgments This book is the product of the enormous, consistent, and coordinated efforts of the excellent team of contributors at Zhongshan Ophthalmic Center, together with the editors at Springer. We are grateful to each and every one of them for their expertise and commitment in building this valuable knowledge base for present and future ophthalmologists around the world. I would also like to thank, in particular, Xiaojian Zhong, Philip Wall, and Zhuoling Lin, for their special contributions to this book. Dr. Zhong has devoted substantial time and energies in the editing and proof-reading of the translated English manuscripts of all 27 chapters; Mr. Wall s dedication has helped improve the text of each chapter into its present form; and Ms. Lin has collected a vast and precious archive of clinical images of pediatric lens diseases, which is indispensable for a book in pediatric ophthalmology. China Yizhi Liu, MD, PhD ix

Contents 1 Embryonic Development of the Human Lens.............. 1 Yongping Li and Yungang Ding 2 Human Visual Development............................. 11 Yongping Li and Yungang Ding 3 Anatomy and Physiology of the Crystalline Lens........... 21 Weirong Chen, Xuhua Tan, and Xiaoyun Chen 4 Etiology of Pediatric Lens Diseases....................... 29 Kaili Wu, Xiaoyun Chen, and Xiaojian Zhong 5 Epidemiology of Pediatric Cataracts...................... 55 Mingguang He and Meng Li 6 Classification and Morphology of Pediatric Cataracts....... 69 Weirong Chen 7 Overview of Pediatric Cataract Treatments................ 85 Xialin Liu, Xinyu Zhang, and Yao Ni 8 History Taking and Specialized Examination of Lens Diseases in Children............................ 101 Jingjing Chen, Haotian Lin, and Weirong Chen 9 Perioperative Challenges and Solutions in the Management of Children with Cataracts.............................. 121 Jingjing Chen, Haotian Lin, and Weirong Chen 10 General Anesthesia in Pediatric Lens Surgery.............. 129 Xiaoliang Gan and Hongfeng Ling 11 Care of Pediatric Lens Surgery.......................... 145 Huiming Xiao 12 Pediatric Cataract Extraction........................... 153 Xinyu Zhang, Lixia Luo, Qianzhong Cao, Haotian Lin, and Yizhi Liu 13 Calculation and Selection of Intraocular Lens Power for Children............................... 177 Danying Zheng, Yi Sun, and Qianzhong Cao xi

xii Contents 14 Selection of Intraocular Lenses for Children............... 187 Haotian Lin 15 Pediatric Intraocular Lens Implantation.................. 193 Haotian Lin, Xinyu Zhang, and Xiaojian Zhong 16 Cataract Surgery in Children with Anomalies of the Uvea... 209 Mingxing Wu, Weirong Chen, and Zhenzhen Liu 17 Ectopia Lentis in Children.............................. 223 Danying Zheng and Qianzhong Cao 18 Cataract Surgery in Children with Preexisting Posterior Capsular Defects.............................. 247 Mingxing Wu, Zhenzhen Liu, and Bo Qu 19 Surgery of Congenital Cataracts Associated with Persistent Fetal Vasculature...................................... 255 Xiaoyan Ding 20 Pediatric Cataract Surgery in Microphthalmic Eyes........ 271 Xinyu Zhang, Xiaojian Zhong, and Xiaoyun Chen 21 Lens Trauma in Children............................... 279 Zhaohui Yuan and Bingsheng Lou 22 Intraoperative Complications and Management............ 295 Xialin Liu and Yao Ni 23 Postoperative Complications and Management............. 309 Xinyu Zhang and Xiaoyun Chen 24 Prevention and Management of Pediatric Secondary Cataracts................................... 329 Mingxing Wu, Zhenzhen Liu, and Liangping Liu 25 Reposition, Explantation, and Exchange of Intraocular Lenses.................................. 337 Danying Zheng 26 Postoperative Visual Rehabilitation in Children with Lens Diseases..................................... 353 Daming Deng, Jinrong Li, and Minbin Yu 27 Quality of Life Assessment in Children with Lens Anomalies................................... 371 Weirong Chen Appendix 1............................................... 379