Safety profile of posterior optic buttonholing (POBH) in pediatric cataract surgery: A Retrospective cross-sectional study.

Sindhu  Kumari; M. Deepak  Lakra; Kuldeep  Chaudhary

doi:10.51168/wcdz7587

Authors

Sindhu Kumari Senior Resident, Department of Ophthalmology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. Author
M. Deepak Lakra Associate Professor, Department of Ophthalmology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India Author
Kuldeep Chaudhary Junior Resident, Department of Ophthalmology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. Author

DOI:

https://doi.org/10.51168/wcdz7587

Keywords:

Safety Profile, Posterior, Optic, Buttonholing

Abstract

Background

Pediatric cataract surgery is associated with a high rate of postoperative complications, particularly posterior capsular opacification (PCO). Posterior optic buttonholing (POBH) has been proposed as a technique to reduce such complications.

Methods

This retrospective cross-sectional study included 108 eyes of 98 pediatric patients (<18 years) who underwent cataract surgery with POBH between 2014 and 2018 at a tertiary eye care center. Data on intraoperative and postoperative complications were analyzed over a minimum follow-up period of 2 years.

Results

The mean age at surgery was 6.5 years. Postoperative complications were minimal, with anterior chamber inflammation in 3 eyes and vitritis in 1 eye. Late complications included intraocular lens (IOL) decentration in 3 eyes and single cases of pupillary capture, posterior capsular opacification, and posterior synechiae.

Conclusion

POBH is a safe and effective technique in pediatric cataract surgery, with a low complication rate and a reduced incidence of PCO.

Recommendations

POBH should be considered as a preferred technique in pediatric cataract surgery, especially in cases at high risk of posterior capsular opacification.

Author Biographies

Sindhu Kumari, Senior Resident, Department of Ophthalmology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.

is a Senior Resident in the Department of Ophthalmology at Rajendra Institute of Medical Sciences, Ranchi, with an interest in pediatric ophthalmology and cataract surgery.
M. Deepak Lakra, Associate Professor, Department of Ophthalmology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

is an Associate Professor specializing in cataract and anterior segment surgeries.
Kuldeep Chaudhary, Junior Resident, Department of Ophthalmology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.

is a Junior Resident with research interests in clinical ophthalmology.

References

Gimbel HV, DeBroff BM. Posterior capsulorhexis with 16. Koch DD, Kohnen T. A retrospective comparison of optic capture: maintaining a clear visual axis after pediatric cataract surgery. J Cataract Refract Surg 1994; 20: 658-664 https://doi.org/10.1016/S0886-3350(13)80659-1

Menapace R. Prevention of posterior capsule opacification. In: Krieglstein, GK, Weinreb, RN, eds. Cataract and Refractive Surgery, Essentials in Ophthalmology.New York, N.Y.: Springer; 2004, 101-112. https://doi.org/10.1007/3-540-26678-X_6

Menapace, R. Posterior capsulorhexis combined with optic buttonholing: an alternative to standard in-the-bag implantation of sharp-edged intraocular lenses? A critical analysis of 1000 consecutive cases. Graefes ArchClinExp Ophthalmol246, 787-801(2008). https://doi.org/10.1007/s00417-008-0779-6 https://doi.org/10.1007/s00417-008-0779-6

Mohan A, Sen P, Jain R, Shah C, Jain E, Sen A. Posterior optic buttonholing of intraocular lens implantation through posterior capsulorrhexis margin: A technique of intraocular lens implantation in cases of anterior capsulorrhexis extension in pediatric cataract surgery. Indian J Ophthalmol. 2021 Apr;69(4):974-977. doi: 10.4103/ijo.IJO_1622_20. PMID: 33727469; PMCID: PMC8012917. https://doi.org/10.4103/ijo.IJO_1622_20

Menapace R. Posterior Optic Buttonholing: Rationale, Surgical Technique and Pearls. American Academy of Ophthalmology [online].[retrieved on Oct. 14, 2010] Retrieved from the Internet.

Spierer A, Desatnik H, Blmenthal M. Refractive status in children after long-term follow-up of cataract surgery with intraocular lens implantation. J Pediatr Ophthalmol strabismus. 1999;36:25-29.doi:10.3928/0191-3913-1999o1o106. https://doi.org/10.3928/0191-3913-19990101-06

Plager DA, Lipsky SN, Snyder SK, Sprunger DT, Ellis FD, Sondhi N. Capsular management and refractive error in pediatric intraocular lenses. Ophthalmology. 1997 Apr;104(4):600-7. doi: 10.1016/s0161-6420(97)30264-4. PMID: 9111251. https://doi.org/10.1016/S0161-6420(97)30264-4

Hosal BM, Biglan AW. Risk factors for secondary membrane formation after removal of pediatric cataract. J Cataract Refract Surg. 2002 Feb;28(2):302-9. doi: 10.1016/s0886-3350(01)01028-8. PMID: 11821214. https://doi.org/10.1016/S0886-3350(01)01028-8

Mohan A, Sen P, Jain R, Shah C, Jain E, Sen A. Posterior optic buttonholing of intraocular lens implantation through posterior capsulorrhexis margin: A technique of intraocular lens implantation in cases of anterior capsulorrhexis extension in pediatric cataract surgery. Indian Journal of Ophthalmology 69(4): p. 974-977, April 2021. | DOI: 10.4103/ijo.IJO_1622_20 https://doi.org/10.4103/ijo.IJO_1622_20

Stifter E, Menapace R, Kriechbaum K, Vock L, Luksch A. Effect of primary posterior continuous curvilinear capsulorhexis with and without posterior optic buttonholing on postoperative anterior chamber flare. Journal of Cataract & Refractive Surgery 35(3): p. 480-484, March 2009. | DOI: 10.1016/j.jcrs.2008.11.041 https://doi.org/10.1016/j.jcrs.2008.11.041