Precision pulse capsulotomy: an automated alternative to manual capsulorhexis in paediatric cataract
Pratik Chougule1, Vivekanand Warkad2, Akshay Badakere1
1Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India.
Insights
Precision pulse capsulotomy (PPC) offers a safe and effective alternative for anterior capsulotomy in pediatric cataract surgery. This technique results in a round, well-centered capsulotomy with a simpler learning curve for surgeons.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Surgical Technology
Background:
- Pediatric cataract surgery presents unique challenges.
- Manual continuous curvilinear capsulorhexis (CCC) can be difficult in pediatric cases.
- Precision Pulse Capsulotomy (PPC) is a novel technique for anterior capsulotomy.
Purpose of the Study:
- To evaluate the operative experience with PPC for anterior capsulotomy in pediatric cataract surgery.
- To assess the safety and efficacy of PPC in a pediatric cohort.
- To compare PPC with manual CCC in terms of outcomes and learning curve.
Main Methods:
- Retrospective interventional, descriptive series of pediatric eyes (≤16 years) undergoing cataract surgery with PPC.
- Surgical and PPC times were recorded.
- Intraoperative and postoperative adverse events, visual acuity, anterior segment examination, and intraocular pressure (IOP) were monitored.
Main Results:
- 21 eyes from 14 pediatric patients were included.
- Median surgical time was 26 minutes; median PPC time was 75 seconds.
- 90% of cases achieved successful in-the-bag intraocular lens implantation with adequate capsulotomy overlap. No adverse events were reported.
Conclusions:
- PPC is a viable alternative to manual CCC in pediatric cataract surgery.
- PPC consistently produces round, well-centered, and robust capsulotomies.
- The technique demonstrates an easier learning curve for surgeons.
Objective:
To report our operative experience with precision pulse capsulotomy (PPC) for anterior capsulotomy in a paediatric cataract series.
Methods And Analysis:
This study is a retrospective interventional, descriptive series of consecutive paediatric eyes (≤16 years) undergoing cataract surgery using PPC. Surgical time and the time required to perform PPC was recorded. Any intraoperative and postoperative adverse events were noted. Postoperatively, visual acuity, anterior segment examination and intraocular pressure (IOP) were recorded for all children at day 1, 1 week and 1 month.
Results:
21 eyes of 14 patients were included in the study, with the median age at surgery of 6.0 years (IQR; 5-7.75, range=1-16 years). Male to female ratio was 11:3. 13 eyes had lamellar cataract, 3 eyes had total cataract, 2 had posterior subcapsular cataract, 2 had traumatic cataract, while 1 eye had sutural cataract. Median surgical time was 26 min (IQR 21-32) and median PPC time was 75.0 secs (IQR 56-86.5). The anterior capsulotomy was round and complete in most cases, except in one case due to faulty suction. All patients underwent a successful in the bag implantation of intraocular lens with capsulotomy margins overlapping the optic edges in 19 eyes (90%). Median PPC size was 5.54 mm (n=9, IQR 5.39 -5.75) which was slightly larger than expected. None of the cases had any intraoperative or postoperative adverse events with no radial tears of capsulotomy. Postoperatively, the mean final follow-up was 5.71+3.20 weeks.
Conclusion:
To conclude PPC can be used as an alternative to manual continuous curvilinear capsulorhexis in paediatric cataract surgery producing round well- centred and strong capsulotomy with an easier learning curve.
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