1. Jump to first page Pediatric Clear Lensectomy for High Myopia Mounir Bashour, M.D., C.M.

2. Jump to first page HPI #1 -- Miss P. n 7 y.o. W. F. n PMHx/NKDA/FHx n -26.00 + 1.75 x 90 OU n Va = 20/100-1 OD/OS n Va = 20/70+ OU n EOM/Balance/SLE n DFE - myopic chorioretinal degeneration

3. Jump to first page HPI #2 -- Mr. O. n 7 y.o. B.M. n PMHx/NKDA/FHx n -20.00 + 1.50 x 90 OU n Va = 20/80 OD/OS n Va = 20/70+ OU n EOM/Balance/SLE n DFE - myopic chorioretinal degeneration

4. Jump to first page Treatment Options n Glasses n Contact Lenses n Refractive Surgery u PRK u Lasik u Clear Lensectomy --> pseudophakia vs aphakia u Other

5. Jump to first page Risks n Intraoperative u expulsive choroidal hemorrhage n Early Post-Op u endophthalmitis u corneal decompensation u persistent uveitis u vitreous hemorrhage n Late u PVD/Retinal Detachment u Aphakic Glaucoma

6. Jump to first page Arguments For n Lensectomy common pediatric procedure with high success rate n Better Vision than with glasses n Aphakic Glaucoma Not Likely n RD same as in pediatric cataract?

7. Jump to first page Arguments Against n Invasive Procedure -- Risks as discussed before n Non-invasive methods available

8. Jump to first page Clear Lensectomy as an Adult Refractive Procedure n Controversial

9. Jump to first page What Now? n Surgery or not? n Retinal Prophylaxis or not? n PCIOL or not?

10. Jump to first page Pediatric Aphakia References F Wheeler DT, Mullaney PB, Awad A, al-Mesfer S, al-Nahdi T, Zwaan J. Pediatric IOL implantation: the KKESH experience [see comments]. J.Pediatr.Ophthalmol.Strabismus. 1997;34:341-6. F Ainsworth JR, Cohen S, Levin AV, Rootman DS. Pediatric cataract management with variations in surgical technique and aphakic optical correction. Ophthalmology. 1997;104:1096-101. F Basti S, Ravishankar U, Gupta S. Results of a prospective evaluation of three methods of management of pediatric cataracts. Ophthalmology. 1996;103:713-20. F Egbert JE, Wright MM, Dahlhauser KF, Keithahn MA, Letson RD, Summers CG. A prospective study of ocular hypertension and glaucoma after pediatric cataract surgery. Ophthalmology. 1995;102:1098-101. F Walton DS. Pediatric aphakic glaucoma: a study of 65 patients. Trans.Am.Ophthalmol.Soc. 1995;93:403-13; discussion 413-20:403-13. F Sinskey RM, Stoppel JO, Amin PA. Ocular axial length changes in a pediatric patient with aphakia and pseudophakia. J.Cataract.Refract.Surg. 1993;19:787-8. F Parks MM, Johnson DA, Reed GW. Long-term visual results and complications in children with aphakia. A function of cataract type. Ophthalmology. 1993;100:826-40.

11. Jump to first page Lensectomy References F Batman C, Cekic O. Clear lensectomy and implantation of IOL for high myopia [letter; comment]. Ophthalmology. 1998;105:944-5. F Colin J, Robinet A. Clear lensectomy and implantation of a low-power posterior chamber intraocular lens for correction of high myopia: a four- year follow-up [see comments]. Ophthalmology. 1997;104:73-7. F Lambert SR, Fernandes A, Grossniklaus H, Drews-Botsch C, Eggers H, Boothe RG. Neonatal lensectomy and intraocular lens implantation: effects in rhesus monkeys. Invest.Ophthalmol.Vis.Sci. 1995;36:300-10. F Balyeat HD. PVD after clear lensectomy for myopia [letter; comment]. Ophthalmology. 1994;101:975-6. F Colin J, Robinet A. Clear lensectomy and implantation of low-power posterior chamber intraocular lens for the correction of high myopia [see comments]. Ophthalmology. 1994;101:107-12. F Colin J, Robinet A. Retinal detachment after clear lens extraction in 41 eyes with high axial myopia [letter; comment]. Retina. 1997;17:78-9. F Javitt JC. Clear-lens extraction for high myopia. Is this an idea whose time has come? [editorial; comment]. Arch.Ophthalmol. 1994;112:321-3. F Verzella F. Refractive microsurgery of the lens in high myopia. Refract.Corneal.Surg. 1990;6:273-5. F Obstbaum SA. Clear lens extraction for high myopia and high hyperopia [editorial; comment] [see comments]. J.Cataract.Refract.Surg. 1994;20:271 F Kirn TF. Ophthalmologic debate: is it reasonable to remove a healthy lens to improve vision? [news]. JAMA. 1987;257:2005 F Koraszewska-Matuszewska B, Forminska-Kapuscikowa M, Samochowiec-Donocikowa E, Duraj J. [Surgical treatment of high myopia in children]. Klin.Oczna. 1986;88:60-1. F Goldberg MF. Clear lens extraction for axial myopia. An appraisal. Ophthalmology. 1987;94:571-82. F Wichmann W. Correction of high myopia by implantation of minus-power intraocular lenses in phakic eyes [letter]. J.Refract.Surg. 1996;12:672- 3. F Balyeat HD, Parke DW, Wilkinson CP. Should we consider clear lens extraction for routine refractive surgery? [letter; comment]. Refract.Corneal.Surg. 1993;9:226-7.