Atlas of Pediatric Cataract 1st ed. 2019 Edition

Atlas of Pediatric Cataract 1st ed. 2019 EditionThis book highlights various pediatric cataracts and their clinical presentations, along with a wealth of high-quality images collected over two decades. Offering a precise guide to illustrative interventions,

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it contains images collected pre-operatively, intra-operatively and post-operatively using slit lamp or microscope integrated cameras. The book covers congenital, developmental and traumatic cataracts, along with other rare morphologies. It presents selected challenging clinical situations, along with surgical management steps that draw on high-quality images.

Separate chapters address recent advances in the field of pediatric cataracts, e.g. ultrasound biomicroscopy, lenticular abnormalities, intraoperative rhexis assistant, plasma blade/ diathermy, vascular cautery in cases of persistent fetal vasculature, operative room aberrometry, and optiwave refractive analysis. Given its scope, the book offers a valuable resource for practicing general and pediatric ophthalmologists, researchers and students alike.

Atlas of Pediatric Cataract 1st ed. 2019 Edition
by Sudarshan Kumar Khokhar (Editor), Chirakshi Dhull (Editor)
ISBN-13: 978-9811369384
ISBN-10: 9811369380

Atlas of Pediatric Cataract 1st ed. 2019 Edition Contents

1 Morphology of Pediatric Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Sudarshan Kumar Khokhar and Chirakshi Dhull
2 Hereditary Cataracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Yogita Gupta, Chirakshi Dhull, and Sudarshan Kumar Khokhar
3 Metabolic Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Abhidnya Surve, Chirakshi Dhull, and Sudarshan Kumar Khokhar
4 Persistent Fetal Vasculature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Chirakshi Dhull and Sudarshan Kumar Khokhar
5 Preexisting Posterior Capsular Defect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Chirakshi Dhull, Barkha Gupta, and Sudarshan Kumar Khokhar
6 Lenticular Subluxation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Sudarshan Kumar Khokhar, Pulak Agarwal, Abhidnya Surve, and Chirakshi
Dhull
7 Spherophakia: A Rare Condition Affecting Pediatric Eyes . . . . . . . . . . . . . . . . . . 67
Sagnik Sen, Chirakshi Dhull, and Sudarshan Kumar Khokhar
8 Pediatric Traumatic Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Chirakshi Dhull, Sourabh Verma, and Sudarshan Kumar Khokhar
9 Pediatric Uveitic Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Chirakshi Dhull, Barkha Gupta, and Sudarshan Kumar Khokhar
10 Cataract with Infective Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Chirakshi Dhull and Sudarshan Kumar Khokhar
11 Cataract in Childhood Glaucoma and Anterior Segment Dysgenesis . . . . . . . . . . 103
Sudarshan Kumar Khokhar, Yogita Gupta, Abhidnya Surve, and Chirakshi
Dhull
12 Cataract in Retinal Pathology and Miscellaneous Conditions . . . . . . . . . . . . . . . . 115
Chirakshi Dhull, Sagnik Sen, and Sudarshan Kumar Khokhar
13 Preoperative Workup and Investigations in Pediatric Cataract Surgery . . . . . . . 127
Chirakshi Dhull, Sagnik Sen, and Sudarshan Kumar Khokhar
14 Surgical Management of Pediatric Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Sudarshan Kumar Khokhar, Chirakshi Dhull, and Yogita Gupta
15 Visual Axis Opacification (VAO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Sudarshan Kumar Khokhar, Yogita Gupta, and Chirakshi Dhull
Contents
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About the Editors

Sudarshan Kumar Khokhar is currently working as Professor at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India. He has more than 20 years of clinical, teaching, and research experience at AIIMS, with particular expertise in pediatric cataracts and complicated adult cataracts. He is a well-published author with over 80 publications in peer-reviewed journals and numerous book chapters.

Over the last decade, Professor Khokhar has offered instruction courses on pediatric cataracts at various national and international conferences, e.g., for the American Academy of Ophthalmology (AAO), European Society of Cataract and Refractive Surgeons (ESCRS), Asia-Pacific Academy of Ophthalmology (APAO), World Ophthalmology Congress (WOC), and American Association for Pediatric Ophthalmology and Strabismus (AAPOS).

Professor Khokhar has designed a special cannula—Khokhar’s capsular painting cannula—for phacoemulsification in white cataracts and was a pioneer in using the plasma blade in persistent fetal vasculature (PFV) eyes. He has received many achievement awards from international bodies, including the APAO and AAO. Chirakshi Dhull is currently working as a Senior Resident in cataract and refractive surgery at the Dr.

Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi. A postgraduate from AIIMS, she has several publications in peer-reviewed journals and book chapters to her credit. She has presented papers at both national and international conferences, including the Asia-Pacific Academy of Ophthalmology (APAO) and Asia-Pacific Glaucoma Congress (APGC)

Atlas of Pediatric Cataract 1st ed. 2019 Edition

Morphology of Pediatric Cataract

Sudarshan Kumar Khokhar and Chirakshi Dhull

Pediatric cataract is a leading cause of childhood blindness. The incidence is in the range of 1.8 to 3.6/10,000 per year and the prevalence is about 1.03 per 10,000 children (0.32–22.9/10,000). There is no difference in the prevalence based on gender or laterality [1]. Untreated cataracts especially in children lead to tremendous social, economical, and emotional burden to the child, family, and society.

Blindness related to pediatric cataract can be treated with early identification and appropriate management. Favorable outcomes depend not just on effective surgery but also on meticulous postoperative care and visual rehabilitation including glasses and amblyopia treatment.

1.1 Morphology of Pediatric Cataract

Examination of cataract morphology remains a challenge. The child is most comfortable in mother’s lap and/or in the shoulder hold. The red reflex screening with direct ophthalmoscope kept at 30 cm and focused on each pupil separately (Bruckner’s test) helps in identification of lenticular opacity in this position. For assessment of specific morphology, slit lamp examination, retroillumination examination, and ultrasound biomicroscopy (UBM) can be used [2–5].

Classification of cataracts on the basis of morphology is useful to ophthalmologists as it adds a clue to etiology and progression [2–3]. It also helps in better planning of surgery and avoiding certain complications associated with particular morphologies. In this classification system, emphasis has been given on the location of opacity in relation to lens structures (Table 1.1).

We have excluded traumatic cataract and persistent fetal vasculature from this classification and discussed them
in detail as separate entities. Cataracts may be visually significant or visually insignificant. However identification of both remains of vital importance as visually insignificant cataracts may progress with age in certain cases. Certain miscellaneous morphology is described in this chapter which the author has encountered in last 20 years…

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