Precision Pulse Capsulotomy (PPC) in Pediatric Cataract Surgery – Initial Results
Ramesh Kekunnaya, FRCS; Pratik S. Chougule, DNB; Vivek Warkad, MS; Akshay Badakere, FRCS
L V Prasad Eye Institute
Introduction: To evaluate the safety and efficacy of new precision pulse capsulotomy (PPC) in pediatric cataract surgery
Methods: It is a retrospective study of all children (age<12years) undergoing cataract surgery using the PPC technique for anterior capsulotomy. Best corrected visual acuity (BCVA) and intra ocular pressure (IOP) were measured pre-operatively; centration and size of the capsulotomy, pupillary dilatation, surgical time and time required for PPC were measured intra-operatively; post operatively BCVA, IOP, centration and size of capsulotomy were noted. Any complications intra or post operatively were noted
Results: 11 eyes of 7 patients (mean age= 6years, range 11months to 9years, 5 boys and 2 girls) were included. Mean PPC time was 91 (±28)seconds (n=8) and mean surgical time was 31.2 (±5.6)minutes. Intra-operatively, all patients had good pupillary dilatation, well-centered, circular and complete capsulotomy of appropriate size, successful intra-ocular lens (IOL) implantation with capsular edge covering the IOL. 2 eyes had inferiorly decentered capsulotomy which was clinically insignificant. 2 eyes had increased post-operative IOP, which was controlled with anti-glaucoma medications. At an average 1month follow-up, no other intraoperative or postoperative complications were noted.
Discussion: Precision pulse capsulototmy has shown circular, centered, strong and consistent outcomes in cadaver, animal and adult human studies (1-3). We found PPC to be effective in pediatric eyes.
Conclusion: PPC is safe, precise and effective in pediatric cataract surgery with a short learning curve. No major complications or change in surgical time was noted.
References: 1. Chang, David F. et al.; Precision Pulse Capsulotomy; Ophthalmology 2016, Volume 123 , Issue 2 , 255 – 264
2. Thompson, Vance M. et al.; Comparison of Manual, Femtosecond Laser, and Precision Pulse Capsulotomy Edge Tear Strength in Paired Human Cadaver Eyes; Ophthalmology, 2016 , Volume 123 , Issue 2 , 265 – 274
3. Waltz, Kevin et al.; Precision pulse capsulotomy: Initial clinical experience in simple and challenging cataract surgery cases; Journal of Cataract & Refractive Surgery 2017, Volume 43 , Issue 5 , 606 – 614