Femtosecond laser - Assisted cataract surgery in pediatric pyramidal anterior polar cataract

Abstract

Purpose The purpose of this report is to describe the successful utilization of femtosecond laser assisted cataract surgery (FLACS) in a rare case of pyramidal anterior polar cataract in a female child. Observations The patient is a 6 years old girl that presented to the cornea clinic with a unilateral pyramidal cataract that was deemed to be visually significant, and therefore required cataract extraction and intraocular lens implantation surgery. FLACS was proposed and mother consented to proceed with the surgery. The femtosecond laser technology enabled precise completion of a central capsulotomy around the protruding pyramidal capsular lesion. Conclusions and importance:conclusion Various capsulorhexis techniques have been described and are used in pediatric cataracts including manual, can opener, vitrectorhexis, and laser, but none has become a standard. We propose the use of femtosecond laser for cataract extraction in cases of pediatric pyramidal cataracts, and hereby provide the first case report of such. The laser is a safe method for capsulorhexis construction and offers an additional advantage of intraoperative anterior segment OCT image guidance with visualization of the pyramidal lesion.

Application of Femtosecond Laser in Challenging Cataract Cases

“…Dick et al 72 Report of FLACS in 4 infants (age range, 2-9 mo old) Successful anterior and posterior capsulotomies using FSL Trifanenkova et al 75 Case series of 51 eyes with pediatric cataract Complete anterior capsulotomy with good centration and size in 48 out of 51 eyes Karas et al 76 Report of a case of pediatric pyramidal anterior polar cataract Safe and complete capsulotomy Corredor-Ortega et al 70 Case series of 6 eyes of 3 children of 6 y or older Successful FSL pretreatment under local anesthesia in cooperative children Fung et al 74 Case series of 5 eyes of 3 children with congenital cataract Successful use of a mobile FSL platform Kalra et al 73 Report of a 13-y-old child with bilateral microspherophakia and lens subluxation Successful use of a mobile FSL platform Tereshchenko et al 77 Case series of 12 eyes of 12 children with congenital cataract combined with primary persistent hyperplastic primary vitreous syndrome Successful anterior and posterior capsulotomies and removal of retrolental membrane using FSL FLACS indicates femtosecond laser-assisted cataract surgery; FSL, femtosecond laser.…”

“…70,72 Anterior capsulorhexis in anterior polar cataract in children may be even more difficult and unpredictable. 76 Karas et al 76 reported that the application of FLACS enabled precise and safe anterior capsulotomy in pediatric pyramidal anterior polar cataract in a 6-year-old child, indicating that FLACS may be a useful option for improving the safety and efficacy of capsulorhexis in anterior polar cataract in pediatric patients. Schultz et al 47 reported a case of successful application of FLACS (Catalys Precision Laser System) for ectopia lentis combined with Marfan syndrome in a 10-year-old boy under general anesthesia.…”

Femtosecond laser-assisted cataract surgery for complex cataracts – A review

“…Some authors have described FLACS for anterior lenticonus through separate case reports. [ 68 69 70 71 72 73 ] Using the LenSx ® system, Ecsedy et al [ 69 ] created a 4.8-mm anterior capsulotomy using a pulse energy of 5 µJ with 4 µm spot separation and 3 µm layer separation. On scanning electron microscopy, there was a uniform serrated profile created through the capsule.…”

“…There are other considerations in a pediatric cataract, including the extra elastic lens capsules, frequent need for primary posterior capsulotomy, and postoperative capsular phimosis. [ 74 ] Karas et al [ 72 ] described performing anterior capsulotomy using the LenSx ® system (4.8 mm capsulotomy size, 5 µJ pulse energy) on a 6-year-old child with anterior polar cataract. Elsewhere, Dick et al [ 75 ] and Dick and Schultz[ 76 ] performed posterior capsulotomies on children using the Catalys ™ system (incision depth 800–1000 µm, diameter between 3.2 and 4.7 mm, pulse energy 8–10 µJ).…”