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Postoperative intraocular pressure elevation after the use of Healon GV in pediatric cataract surgery
1Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA.
Insights
Pediatric cataract surgery using Healon GV can cause significant intraocular pressure spikes. Meticulous removal of viscoelastic agents is crucial to prevent this complication in children.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Ocular Pharmacology
Background:
- Postoperative intraocular pressure (IOP) elevation is a known complication of viscoelastic agent use in adult cataract surgery.
- Pediatric patients are generally presumed to have better clearance of viscoelastic agents due to healthier trabecular meshwork.
Observation:
- A series of 4 pediatric eyes (ages 5-14) experienced marked IOP elevation (>30 mm Hg) after cataract extraction with Healon GV.
- Symptoms included nausea, eye pain, and microcystic corneal edema, occurring 1 day postoperatively.
- This complication arose after switching to a higher viscosity viscoelastic agent, Healon GV, with incomplete removal during surgery.
Findings:
- Healon GV use in pediatric cataract surgery was associated with significant, symptomatic IOP elevation in this case series.
- Medical management effectively controlled IOP in all cases, preserving visual outcomes.
- One patient required hospitalization for dehydration due to persistent nausea and vomiting.
Implications:
- The choice of viscoelastic agent and meticulous intraoperative removal are critical in pediatric cataract surgery to prevent IOP spikes.
- Careful management of Healon GV is necessary in pediatric patients to avoid severe postoperative complications.
- Implementing thorough viscoelastic removal protocols can prevent recurrence of this issue.
Abstract:
Intraocular pressure elevation after the use of viscoelastic agents in uncomplicated cataract surgery has been well documented in adults. However, pediatric patients are thought to clear residual viscoelastic agents from the anterior chamber more easily than adults, presumably because of healthier trabecular meshwork. (1) We report on a series of 4 eyes of 4 children with previously normal intraocular pressure who underwent cataract extraction with primary (3 patients) or secondary (1 patient) intraocular lens implantation with Healon GV, which was complicated by marked postoperative intraocular pressure elevation (greater than 30 mm Hg). The patients, aged 5 to 14 years, had an intraocular pressure ranging from 34 to 50 mm Hg with Tonopen or applanation tonometry 1 day, postoperatively associated with nausea, eye pain, and microcystic corneal edema. Viscoelastic material was not entirely removed during surgery. Each of these cases occurred after a change in our preferred viscoelastic agent from one with less viscosity to Healon GV. Medical management controlled the elevated intraocular pressure in all cases without affecting the visual outcome. However, 1 patient with intractable nausea and vomiting required hospitalization for rehydration. With meticulous removal of all viscoelastic material at the completion of surgery, we have not documented any additional cases of postoperative pressure elevation.