Bilateral Simultaneous Surgery

While most pediatric ophthalmologists advocate removing bilateral cataracts as two separate procedures to minimize the risk of bilateral endophthalmitis, others favor bilateral simultaneous surgery in selected patients in order to decrease the number of times general anesthesia will be required, to rehabilitate both eyes simultaneously and to reduce the cost of the procedures [16]. Bilateral simultaneous cataract surgery has also been advocated in adults requiring general anesthesia [17]. In children, it has been proposed that bilateral simultaneous surgery be reserved for children who are at increased risk of complications with general anesthesia (Fig. 6.6) [50]. Extra precautions should be taken to minimize the risk of endophthalmitis such as using a different set of surgical instruments for each eye.

Fig. 6.6 a, b. Bilateral nuclear cataracts in a 4-week-old boy with Lowe syndrome and renal dysfunction. Bilateral simultaneous lensectomies were performed to obviate the need for multiple sessions of general anesthesia. Postoperatively the child was fit with rigid gas permeable contact lenses

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