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Pediatric Clear Lensectomy for High Myopia

Mounir Bashour, M.D., C.M.

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HPI #1 -- Miss P.

7 y.o. W. F. PMHx/NKDA/FHx -26.00 + 1.75 x 90 OU Va = 20/100-1 OD/OS Va = 20/70+ OU EOM/Balance/SLE DFE - myopic chorioretinal

degeneration

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HPI #2 -- Mr. O.

7 y.o. B.M. PMHx/NKDA/FHx -20.00 + 1.50 x 90 OU Va = 20/80 OD/OS Va = 20/70+ OU EOM/Balance/SLE DFE - myopic chorioretinal

degeneration

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Treatment Options

Glasses Contact Lenses Refractive Surgery

PRK Lasik Clear Lensectomy -->

pseudophakia vs aphakia Other

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Risks Intraoperative

expulsive choroidal hemorrhage Early Post-Op

endophthalmitis corneal decompensation persistent uveitis vitreous hemorrhage

Late PVD/Retinal Detachment Aphakic Glaucoma

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Arguments For Lensectomy common pediatric

procedure with high success rate Better Vision than with glasses Aphakic Glaucoma Not Likely RD same as in pediatric cataract?

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Arguments Against

Invasive Procedure -- Risks as discussed before

Non-invasive methods available

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Clear Lensectomy as an Adult Refractive Procedure

Controversial

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What Now?

Surgery or not? Retinal Prophylaxis or not? PCIOL or not?

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Pediatric Aphakia References Wheeler DT, Mullaney PB, Awad A, al-Mesfer S, al-Nahdi T, Zwaan J. Pediatric IOL

implantation: the KKESH experience [see comments]. J.Pediatr.Ophthalmol.Strabismus. 1997;34:341-6.

Ainsworth JR, Cohen S, Levin AV, Rootman DS. Pediatric cataract management with variations in surgical technique and aphakic optical correction. Ophthalmology. 1997;104:1096-101.

Basti S, Ravishankar U, Gupta S. Results of a prospective evaluation of three methods of management of pediatric cataracts. Ophthalmology. 1996;103:713-20.

Egbert JE, Wright MM, Dahlhauser KF, Keithahn MA, Letson RD, Summers CG. A prospective study of ocular hypertension and glaucoma after pediatric cataract surgery. Ophthalmology. 1995;102:1098-101.

Walton DS. Pediatric aphakic glaucoma: a study of 65 patients. Trans.Am.Ophthalmol.Soc. 1995;93:403-13; discussion 413-20:403-13.

Sinskey RM, Stoppel JO, Amin PA. Ocular axial length changes in a pediatric patient with aphakia and pseudophakia. J.Cataract.Refract.Surg. 1993;19:787-8.

Parks MM, Johnson DA, Reed GW. Long-term visual results and complications in children with aphakia. A function of cataract type. Ophthalmology. 1993;100:826-40.

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Lensectomy References Batman C, Cekic O. Clear lensectomy and implantation of IOL for high myopia [letter; comment]. Ophthalmology. 1998;105:944-5.

Colin J, Robinet A. Clear lensectomy and implantation of a low-power posterior chamber intraocular lens for correction of high myopia: a four-year follow-up [see comments]. Ophthalmology. 1997;104:73-7.

Lambert SR, Fernandes A, Grossniklaus H, Drews-Botsch C, Eggers H, Boothe RG. Neonatal lensectomy and intraocular lens implantation: effects in rhesus monkeys. Invest.Ophthalmol.Vis.Sci. 1995;36:300-10.

Balyeat HD. PVD after clear lensectomy for myopia [letter; comment]. Ophthalmology. 1994;101:975-6.

Colin J, Robinet A. Clear lensectomy and implantation of low-power posterior chamber intraocular lens for the correction of high myopia [see comments]. Ophthalmology. 1994;101:107-12.

Colin J, Robinet A. Retinal detachment after clear lens extraction in 41 eyes with high axial myopia [letter; comment]. Retina. 1997;17:78-9.

Javitt JC. Clear-lens extraction for high myopia. Is this an idea whose time has come? [editorial; comment]. Arch.Ophthalmol. 1994;112:321-3.

Verzella F. Refractive microsurgery of the lens in high myopia. Refract.Corneal.Surg. 1990;6:273-5.

Obstbaum SA. Clear lens extraction for high myopia and high hyperopia [editorial; comment] [see comments]. J.Cataract.Refract.Surg. 1994;20:271

Kirn TF. Ophthalmologic debate: is it reasonable to remove a healthy lens to improve vision? [news]. JAMA. 1987;257:2005

Koraszewska-Matuszewska B, Forminska-Kapuscikowa M, Samochowiec-Donocikowa E, Duraj J. [Surgical treatment of high myopia in children]. Klin.Oczna. 1986;88:60-1.

Goldberg MF. Clear lens extraction for axial myopia. An appraisal. Ophthalmology. 1987;94:571-82.

Wichmann W. Correction of high myopia by implantation of minus-power intraocular lenses in phakic eyes [letter]. J.Refract.Surg. 1996;12:672-3.

Balyeat HD, Parke DW, Wilkinson CP. Should we consider clear lens extraction for routine refractive surgery? [letter; comment]. Refract.Corneal.Surg. 1993;9:226-7.