Fig. 1. А-scan and B-scan of the eye globe
Fig. 2. Patient: А) Pre-op; В) Post-op after bandage removal
An operation to remove cataracts with bilateral congenital cataracts has always been controversial and should be undertaken with great care, performed in complete aseptic technique, with strict separation of the right and left operations. Unilateral complication after cataract surgery with bilateral congenital cataract is comparable to those reported after unilateral cataract surgery. Bilateral complications are rare, with lateral endophthalmitis being the greatest fear.
Surgeons and their patients should be prepared to set aside the second eye for surgery if there is any complication with the first eye. Cataract surgery with bilateral congenital cataracts benefits patients by preventing re-anesthesia, unnecessary economic costs and amblyopia. Facilitates our goal of visual rehabilitation.
The history and prevalence of simultaneous bilateral cataract surgery: a sequential cataract surgery on the same day, was first performed in 1952 [1].
Historically, cataract surgery with bilateral congenital cataract was performed initially with extracapsular cataract extraction (ICCE), and then with extracapsular cataract extraction (ECCE), and phacoemulsification, with larger series originating from the UK [1, 3-6].
To our knowledge, countries where cataract surgery with bilateral congenital cataracts is usually performed with increasing interest and safety include: Australia, Austria, Canada, China, Finland, Great Britain, Iran, Israel, Japan, Turkey, South Africa, Spain , Sweden, Poland and the United States of America and others [2].
Clinical case
The mother of the girl returned to us for an appointment 1 year 7 months. The family is the youngest and has 6 more brothers. Parents noticed a slight clouding in the pupil when she was 1 year old. Also, a father and 3 brothers were operated on for congenital cataracts.
Biomicroscopy: OU - From the cornea there is no pathology. The anterior chamber is of the correct shape and depth. In the area of the pupil, a turbidity is white. In both cases there is a symmetric nuclear cataract.
Fundus: no pathology.
Ultrasound examination without pathology (Fig1).
Light sensation is available on both sides. In tracking the object is difficult. Passed a consultation with a pediatrician and anesthetist. There are no systemic diseases. A simultaneous cataract surgery with bilateral congenital cataract under general anesthesia was planned.
Operation: It was carried out under general anesthesia from the beginning of the right and then the left eye. The anterior and posterior capsulorexis, the nucleus was taken with a vitreotome, then the cortex is aspirated further by the aspiration cannula. The artificial lens was not set. An antibiotic was injected into the anterior chamber. Side ports were not sewn up, only hydration was done. Both eyes were covered with a blindfold. The next day the bandage was removed (Fig. 2). During the operation, surgical asepsis was carefully observed.
Conclusion
Bilateral cataract surgery in a single session can be a safe and useful approach, an alternative to sequential surgery in individual patients, if operational guidelines and surgical asepsis are strictly followed.
