PREOPERATIVE DIAGNOSIS: Congenital cataract, left eye.
POSTOPERATIVE DIAGNOSIS: Congenital cataract, left eye.
OPERATION PERFORMED:
1. Lensectomy, left eye.
2.
3.
Anterior vitrectomy and posterior capsulectomy, left eye.
EyeQ A-scan ultrasonography for barometric measurement, both eyes.
SURGEON: Douglas R. Fredrick, MD
ASSISTANT: Ta Chen Chang, MD
ANESTHESIA: General.
INDICATIONS: The patient is a 15-month-old boy with a history of anterior polar cataract which is progressing, causing amblyopia and strabismus. There has been no response to patching. Risks, benefits, alternatives, and complications with special emphasis on use of intraocular lenses versus contact lenses, were discussed with the parents. They wish to proceed without use of an intraocular lens implant.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room where general anesthesia was induced by anesthesia staff. At this time, intraocular pressure was measured and found to be 8 on the left and 9 on the right. A Tono-Pen was used. At this time, the EyeQ Ascan ultrasonography was used to perform ultrasonography on both eyes to measure for intraocular lens implantation. After this was concluded, the eye was prepped and draped in the sterile ophthalmic fashion exposing the left eye under the operating microscope. A 6-0 silk suture was placed in the superior rectus muscle to serve as a traction suture. A superior limbal peritomy was performed with
Westcott scissors. Electrocautery was used for hemostasis. A 69-blade was used to create a groove at the posterior surgical limbus. The anterior chamber was entered using the __________ Beaver blade. The cystitome was used to dissect the capsule away from the iris adhesion which was located nasally. The anterior capsular plaque was densely adherent to the capsule and incorporated so that in removing that plaque there was a tear in the anterior capsule. An anterior capsulotomy was performed. At this time, a Simcoe irrigation/aspiration handpiece was used to remove all nuclear cortical material. This left a round anterior capsulotomy and an intact posterior capsule. At this time, the wound was opened after Healon was placed. The __________ Beaver blade was used to open the wound. At this time, the Alcon Accurus unit was used to create a posterior capsulectomy and anterior vitrectomy. This left a 5-millimeter posterior capsulectomy with a good posterior rim 360 degrees.
__________ anterior chamber and pupil became rather constricted. There was no vitreous at the wound. The wound was closed with interrupted
10-Vicryl suture. The wound was watertight. The conjunctiva was closed with 10-0 plain gut suture. A peripheral iridectomy was performed superiorly before closure of the wound. At the conclusion of the procedure, the anterior chamber was deep and quiet. Pupil was round and constricted. There was no vitreous at the wound. Cefazolin, ceftazidime and Celestone were injected subconjunctivally at the end of

the case. The traction stitch was removed. Atropine ointment and
Maxitrol ointment were placed in the eye. A soft eye patch was carefully placed over the eye. The patient was extubated and taken to the PACU in good condition.
There were no complications.