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Friday, October 11, 2013

Pediatric surgery: the best and worst surgeries to do

One of the absolute most fun things I get to do is take pictures with kids after surgery. Usually this means that their surgery went well, so family and child are happy to oblige. The actual performing of the surgery on a child, I don't like so much, and every time in the middle of surgery I ask myself why I endure the mental anguish.  For anybody who has done pediatric cataract surgery you understand. The following photos and stories are the reason. We have done close to 100 pediatric cataract surgeries this year alone and I wanted to take a moment to share a few great stories from surgeries I did this week.
First, I'll share about this family of three boys. I was touched deeply since the kids were nearly identical in age to my 3 boys. The oldest Dionisio, middle Evaristo, and youngest Nelson were all born with congenital lens opacities. Their family lives about 16 hours away by car, and a 2-3 day bus journey. Unfortunately they had never had surgery before, so they all had nystagmus  (the eyes moved all the time signifying poor vision potential, amblyopia). BUT.... I just can't leave them that way when I think there might be a chance, so we did surgery on them all the same day and this photo is after the second eyes were done. Fortunately they all cooperated for local anesthesia.
Despite the nystagmus, the vision was definitely improved and all lenses were in the posterior chamber nicely secure. We will continue to observe them and I'm optimistic that vision will improve with time.  I'm so grateful we got to help these awesome family.
Below is Zeferina. She got hit in the right eye by a rock and was left with a large, white cataract. I am always cautious with traumatic cataracts as they can present challenges unique from standard cases. Upon completion of the rhexis, I noticed a forward pressure coming from the soft lens nucleus, a little hydrodissection confirmed the presence of vitreous as there was an almost perfectly oval defect in the posterior capsule with fibrosed margins. A complete anterior vitrectomy to remove cortical remains and a lens was placed in the capsular bag. Vision today was 20/80 uncorrected. Doesn't she look adorable? Ok, Ok I get it Angolans as a rule don't like to smile for pictures (if this is your first time reading the blog, it's a recurring theme).

Ernesto is 9 years old. He was born with congenital cataracts that grew over the last several years. He did not have nystagmus, and I was very optimistic about his vision chances. He however, did not agree with the local anesthesia as whenever he felt something ( drop of water on this eyelid, movement around his face from my hands, etc...) He flinched his head from side to side. Very difficult to work like that when you have sharp instruments inside the eye. Unfortunately, I only learned about his reaction after the eye was already opened, in fact during the capsulorhexis, which was not completed successfully; not a coincidence.  Gratefully, I had enough intact capsule to place a lens optic in the bag with haptics in the sulcus. His vision was 20/60 today and I only had to joke around with him a little bit to get this half smile. I love the tuxedo shirt.
Please keep Angola and the rest of the developing world in your prayers as there are thousands of needlessly blind children just like these waiting for their miracle. What can you do to be apart of the cure?