Postoperative Complications and Management
The high incidence of complications after pediatric lens surgery is a bothersome issue for surgeons that may affect postoperative outcomes. Due to greater inflammatory response and immature blood-aqueous barrier, complications such as uveitis, posterior c
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Xinyu Zhang and Xiaoyun Chen
Abstract
The high incidence of complications after pediatric lens surgery is a bothersome issue for surgeons that may affect postoperative outcomes. Due to greater inflammatory response and immature blood-aqueous barrier, complications such as uveitis, posterior capsule opacification, secondary glaucoma, and IOL malposition are frequently seen after pediatric lens surgery. These complications may pose a serious impact on the ocular development and the visual function reconstruction of pediatric patients. This chapter will provide comprehensive and detailed information on the pathogenesis, risk factors, diagnosis, preventive strategies, and management of various postoperative complications.
Cataract extraction is the predominant method of treatment for pediatric cataracts. Due to the special anatomical structures and physiological functions of pediatric eyes, the necessary surgical techniques are demanding and different from those in adults, with a higher incidence of postoperative complications, including uveitis, posterior capsule opacification (PCO), glaucoma, and IOL decentration or dislocation. Meanwhile, the postoperative complications in pediatric patients usually have insidious onset and are prone to misdiagnosis, which leads to delayed treatment,
poor surgical outcomes, and even secondary blindness. Therefore, prevention and management of postoperative complications in pediatric cataract surgeries are crucial issues for improving surgical outcomes and reducing postoperative low vision/blindness, and this poses great challenges to practicing ophthalmologists. This chapter will illustrate in detail the causes, preventions, and managements of postoperative complications for pediatric cataracts.
23.1 X. Zhang, MD, PhD (*) • X. Chen State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54S Xianlie Road, Guangzhou 510060, People’s Republic of China e-mail: [email protected]
Complications Associated with the Cornea
23.1.1 Corneal Edema Corneal edema is one of the early postoperative complications for pediatric cataracts (Fig. 23.1).
© Springer Science+Business Media Singapore 2017 Y. Liu (ed.), Pediatric Lens Diseases, DOI 10.1007/978-981-10-2627-0_23
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Fig. 23.1 Corneal edema after cataract surgery. A 5-yearold child develops diffuse corneal edema on postoperative day one. Slit-lamp image shows marked corneal haze
23.1.1.1 Etiology 1. Surgical trauma Intraoperative mechanical damage is the leading cause of postoperative corneal edema. Considering the restricted operating space due to the small eyeball and shallow anterior chamber of children, corneal endothelial injury tends to occur when surgical instruments are introduced in and out of the anterior chamber or an IOL is implanted. In addition, Descemet membrane detachment (DMD) caused by improper manipulation and excessive anterior chamber irrigation may also cause damage to the corneal endothelium. The rate of postoperative corneal endothelial cell loss is estimated t
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