Paediatric cataract surgery with posterior capsulorhexis
Channel: Prof. DD VERMA
Date: 10/07/2020

Paediatric cataract surgery is different from adult cataract surgery in many aspects. 
1) Timing - Surgery should be done at the earliest age possible when the child is fit for general anesthesia, to prevent amblyopia.
2) IOL power calculation- It is a challenging task as the power keeps changing due to the growing eyeball. IOL power is kept in under-correction, for which there are various formulae available.  
3) Scleral rigidity is low in children. So any inadvertent pressure should be avoided while applying speculum. 
4) Anterior lens capsule in children is thinner and more elastic and has stronger zonular forces acting on it. So there are higher chances of rhexis extension. For better control of rhexis, cohesive viscoelastic should be used.  Anterior chamber should be maintained at all points, and the flap should be grasped near the tearing edge of the rhexis for better control.
5) Paediatric nucleus is soft, so phaco power is not required. Entire lens can be aspirated by I/A probe.
6) Posterior capsulorhexis is done routinely in all paediatric cases to prevent amblyopia, as PCO formation occurs within a year. For better visualization during posterior capsulorhexis, few cortical fibers may be left intentionally on posterior capsule during I/A. 
7) Posterior capsule is more elastic and thin as compared to anterior capsule. Therefore it is required to always hold the flap near the tearing edge. A 3 to 3.5 mm opening should be made.
8) If there is no vitreous in anterior chamber after posterior capsulorhexis, IOL can be placed in the bag. IOL implantation should be done under cohesive viscoelastic so that capsular bag is formed. Try not to rotate the IOL after implanting, as the posterior capsule is open. 
9) After IOL implantation,  anterior vitrectomy is done. Always make sure to wash out viscoelastic from the anterior and posterior chamber to prevent post-op secondary glaucoma, iritis and vitritis.
10) Wound sealing is difficult as corneal lamellae are immature. The main port and side port may be sutured as children may keep rubbing eyes.
11) Post-op follow up should be more frequent to check for inflammation and rise in IOP

By:- DR D D VERMA DIRECTOR D D EYE INSTITUTE, PHACO, CORNEA & REFRECTIVE SURGEON IN KOTA, RAJASTHAN , INDIA. CONTACT NO. +9414181161, MAIL US AT drddverma@yahoo.com PHACOEMULSIFICATION, CATARACT SURGERY & CONDUCT SHORT & LONG TERM HANDS ON PHACO NATIONAL/ INTERNATIONAL FELLOWSHIP PROGRAMME.