Luanna R. Bartholomew

Pediatric cataract surgery and intraocular lens implantation: Practice styles and preferences of the 2001 ASCRS and AAPOS memberships☆

&NA; A survey of pediatric cataract surgery and intraocular lens (IOL) implantation practice patterns of adult and pediatric cataract surgeons was performed in October 2001. Questionnaires were distributed to the American Society of Cataract and Refractive Surgery and the American Association for Pediatric Ophthalmology and Strabismus. The overall return rate was 12.6% and 41.0%, respectively. Results show that pediatric cataract surgery with IOL implantation is being performed at a younger age than 8 years ago. Also, pediatric cataract surgery practice patterns are evolving in step with advances in adult surgery but with notable differences.

Extensibility and scanning electron microscopy evaluation of 5 pediatric anterior capsulotomy techniques in a porcine model

PURPOSE: To compare the extensibility and scanning electron microscopy (SEM) of 5 currently used pediatric anterior capsulotomy techniques: vitrectorhexis, manual continuous curvilinear capsulorhexis (CCC), can‐opener, radio frequency diathermy, and plasma blade in a porcine model. SETTING: Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Extensibility was determined by stretching each capsulotomy until it ruptured and measuring it by calculating the mean stretch‐to‐rupture circumference of each capsulotomy (20 eyes per technique) as a percentage of its baseline circumference. Edge characteristics were evaluated using SEM. RESULTS: The mean extensibility of each technique tested (vitrectorhexis 161%, CCC 185%, can opener 149%, radio frequency 145%, plasma blade 170%) was significantly different (P<.001, 1‐way analysis of variance). The SEM examination found that the vitrectorhexis had a scalloped edge with the whole edge rolled over, presenting a smooth surface toward the inside of the capsulotomy; the manual CCC produced the smoothest edge, with no irregularities noted; the can‐opener edge was irregular, showing each puncture of the needle had created a small arc, with occasional regions of the edge rolled over in a “hit‐and‐miss” fashion; the radio‐frequency diathermy capsulotomy edge was ragged, rough, and irregular; and the plasma blade capsulotomy edge was rougher than the manual CCC, but there were fewer irregularities than the radio‐frequency diathermy edge had. CONCLUSIONS: The manual CCC technique produced the most extensible porcine capsulotomy, followed by the plasma blade, vitrectorhexis, can‐opener, and radio‐frequency techniques, in a porcine model. The manual CCC technique also produced the smoothest anterior capsulotomy edge according SEM evaluation.

Pediatric anterior capsulotomy preferences of cataract surgeons worldwide: comparison of 1993, 2001, and 2003 surveys.

&NA; We compared the pediatric anterior capsulotomy preferences of members of the American Society of Cataract and Refractive Surgery (ASCRS) and the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) reported in 3 surveys (1993, 2001, and 2003). In 1993 and 2001, more than 50% of ASCRS respondents preferred manual anterior capsulotomy techniques; in 2001 and 2003, AAPOS respondents preferred manual and vitrector techniques. The ASCRS preferences remained unchanged when subdivided into domestic and international, as did AAPOS domestic preferences; however, more than 50% of AAPOS international preferences changed from manual alone in 2001 to a manual–vitrector combination in 2003. In 2003, more than 50% of AAPOS respondents worldwide preferred this combination: the vitrector for the very young patient and the manual anterior capsulotomy for the older child.

Outflow resistance of the Baerveldt glaucoma drainage implant and modifications for early postoperative intraocular pressure control.

PurposeTo determine outflow resistance of the Baerveldt glaucoma implant using different tube configurations. MethodsOutflow resistance of 6 tube configurations (C1– C6) of Baerveldt implants was measured under conditions of constant pressure perfusion. Pressures ranged from 2 to 55 mm Hg. Venting slits were created using a 7-0 Vicryl, spatulated suture-needle. Seton tubes were occluded by threading a retrograde suture ∼1.5 cm into the lumen. ResultsAt pressures between 2 and 55 mm Hg, mean outflow resistance of the normally configured seton (ie, open tube; C1) was 0.41 (± 0.6) mm Hg/μL/min. Resistance was unchanged (mean 0.41 (± 0.4) mm Hg/μL/min) by the addition of 4 venting slits (C2) to the seton tube. Occlusion of the open seton tube with a 3-0 Supramid® suture (C3) significantly increased (P < 0.001) mean outflow resistance to 14.99 (± 0.6) mm Hg/μL/min. Occlusion of the tube with a 4-0 Supramid® suture (C4) significantly increased (P < 0.001) mean outflow resistance to 1.09 (± 0.5) mm Hg/μL/min. In implants where tubes were occluded with a 3-0 Supramid® suture, the addition of venting slits (C5) significantly decreased (P = 0.038) mean outflow resistance to 8.98 (± 0.4) mm Hg/μL/min. In tubes occluded with a 4-0 Supramid® suture, the addition of venting slits (C6) decreased mean outflow resistance to 0.98 (± 0.6) mm Hg/μL/min. ConclusionsAlthough these results cannot be directly correlated to the clinical setting, they do show that outflow resistance can be modified at the time of surgery by changing tube configuration of the Baerveldt glaucoma implant. Configuration C5 (3-0 Supramid® with venting slits) closely approximates the outflow rate in the normal intraocular pressure range.