Preoperative usage of ultrasound biomicroscopy in pediatric cataract

Abstract

Uso pré-operatório de biomicroscopia ultrassônica em catarata pediátricaDear Editor: I read the article "Epilens membrane simulating cataract in children with uveitis: a report of three cases" by Paiva et al. with great interest (1) . Three cases were presented that were diagnosed as cataract secondary to uveitis but that were understood to have received treatment for pupillary membrane intraoperatively. I congratulate the authors for their attention and good management.Cataract surgery is a radical operation in children (2) and may cause quite a few complications; patients will also require follow-up after operation. The indication for cataract surgery in children should be evaluated carefully. Preoperative examination and imaging are critical for deciding on whether to operate or not and to identifying opera tion strategy. Ultrasound biomicroscopy (UBM) could be a good ima ging method to diagnose epilens membrane in these cases (3) .UBM is a non-invasive method that allows imaging of structural details of the anterior segment and the lens. UBM could visualize the epilens membrane and divulge the transparency of the lens. Ne vertheless, it is a great advantage to be able to differentiate the membrane intraoperatively without damaging the anterior capsule.

Ultrasound biomicroscopy in the management of complex cataract and intraocular lens: A review

“…Epilens membrane may simulate cataract in paediatric uveitic eyes despite a clear lens 33 . Preoperative UBM can assess for the presence of any cataract, 34 and the surgeon should take care to avoid anterior capsule breach during the release of the pupillary membrane and synechiolysis if the lens is clear.…”

Pediatric cataract

“…The preexisting posterior capsular defect presents as a total cataract or sometimes a differential opacity (more white at the center than in the periphery), white dots on posterior capsule or anterior vitreous, and a fish-tail sign. [ 31 ] The diagnosis can be confirmed on ultrasound biomicroscopy[ 33 ] [ Fig. 3 ].…”

“…USG helps us rule out retinal detachment, fundal coloboma, and retinoblastoma. [ 33 ] USG in a case of unilateral cataract can diagnose a PFV. [ 50 ] Magnetic resonance imaging can be ordered if there is a high degree of suspicion of PFV which is missed on USG.…”

Tip of the iceberg: congenital cataract with pre-existing posterior capsule defect (PPCD): how vital is the role of ultrasound biomicroscopy?

“…Anterior segment examination of the LE with fully dilated pupil showed total cataractous lens with invisible posterior capsular details (figure 1A). Ultrasound biomicroscopy (UBM) of the LE showed a large posterior capsular defect with subluxation of the lens into the vitreous cavity1 beyond the capsule (figure 1B). Care was taken to avoid lens drop during irrigation–aspiration.…”