Minor shift, major improvement
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Christopher Cooper of Marion was just two months old when he had his first eye surgery at University of Iowa Children’s Hospital in 2010.
Born with congenital cataracts in both eyes, Christopher needed the early surgeries to remove the cataracts and move toward a corrected vision. During a routine doctor’s visit three months after cataract surgery, doctors saw blood and scar tissue inside one eye. A second surgery with a vitreoretinal specialist was needed to repair the delicate structures and remove the matter, which otherwise would have left Christopher blind in that eye.
When vitreoretinal surgeon Vinit Mahajan approached Christopher’s mother, Marsha Cooper, about performing the second surgery in a way that could reduce recovery time, Marsha said she was optimistic.
“After his first surgery his eye really looked the way you would expect it to look after surgery—it was red and we had to put in drops and ointments but you really just didn’t want to touch it,” Marsha says.
After the second surgery, however, there was a noticeable difference, she says. The eye wasn’t as red and it seemed to heal in less time.
“You could tell he’d had surgery, but there wasn’t nearly the same amount of redness; it looked a thousand times better,” Marsha says. “It seemed to heal faster, better.”
“Operating within an infant eye presents special challenges, especially when it’s filled with blood,” says Mahajan. “Even when surgery is successful, healing is tough on kids and parents.”
But Mahajan, M.D., Ph.D., UI assistant professor of ophthalmology and visual sciences, has developed a modified surgical method, changing the point of entry from the white sclera at the front of the eye to the limbus near the clear cornea.
Though the change redirects the point of entry by just a few millimeters, it can mean a major difference to both patient and surgeon.
In a study to be published in RETINA The Journal of Retinal and Vitreous Diseases in May and currently online, Mahajan discusses how the modified procedure for retinal surgery on infants and young children can be safer, reduce the possibility of injury, and shorten recovery time.
"The difference in where we make the first surgical incisions is just a few millimeters, but it can give the surgeon a safer approach," says Mahajan, the senior author on the paper.
“To repair the retina inside of the eye, ophthalmologists traditionally insert instruments through the parsplana. But there can be severely traumatized or diseased tissue hidden at this location,” he says. “By moving the entry point forward to the limbus, we can avoid any additional injury.”
The surgery is typically performed to repair or remove diseased tissue inside the eye. The UI study reported on 10 infants and children—including Christopher—who underwent the modified surgery for a variety of reasons, including complications of congenital cataract, intraocular hemorrhage, glaucoma, genetic disorders, and non-accidental trauma.
“Because the surgery is started in this new location, there are fewer sutures required and less tissue disruption,” Mahajan says.
Co-author Polly Quiram, M.D., Ph.D., a pediatric retina specialist at Vitreo Retinal Surgery PA in Edina, Minn., noted, “Recovery time is shorter with less inflammation and scar formation, giving these children a jump on earlier healing.”
Christine Kay, M.D., former UI retina fellow and co-author, added, "These are very subtle changes but they can make a huge difference."