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DISCUSSION

            Aphakia is a
condition of eye where there is no crystalline lens in which in this case is
due to congenital cataracts. It makes the patient to experience a loss of
accommodation and thus exhibit a condition of far sightedness. However, after
the cataract surgery there was absence of history information whether the patient
was corrected with any aphakic spectacle or contact lenses. But there was no
possibility that this patient was corrected with Intraocular Lens (IOL),
because it is impossible for congenital cataracts cases to be implanted with IOL
at age less than 6 months. For example in this case of 3 months old baby, IOL
power of about 28-30 D may be necessary for emmetropia and would cause significant
myopia in later life if it was implanted because infants experience large
myopic shifts due to axial growth and rapid eye changes. The major myopic
progression occurred during the first 1 year. Therefore, aphakic patient may
need either contact lens or spectacle at younger age because it is easier to
change power of their eye soon instead of IOL.

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            Moreover,
although the patient had cataract surgery during early infancy the patient
still encountered visual impairment which is his best corrected visual acuity
was decreased at both distance and near. Visual development has been shown to
be severely affected by visual deprivation. Most people develop low vision as a consequence of
eye conditions and diseases. So in this case this patient is aphakic. Aphakia cause the eye to unable maintain its focus
on an object as that object moves closer or farther away due to loss of
accommodation. Therefore, it is best for the patient to use a hand-held magnifier and
other low vision device instead of large printed books while reading because he can also perform other task too using
that magnifier. This patient also been referred to contact lens clinic. After
fit with contact lenses, however the improvement were not measurable on Snellen
acuity, but the patient himself  aware of
the significant improvement which were measureable through the increase in
peripheral awareness compared to the high plus and thick spectacle lenses . The
magnification factor is very low with contact lenses and there is also no
spherical aberration and the visual field is full. From the findings, it can be
seen that the power for CL is higher than the refractive power. It is because when
lens dehydration occurs on the eye, lenses may reduce several dioptres of plus
power. Therefore, it is necessary for aphakic lens to be made in an even
higher plus power to allow for this power reduction to occur on the eye.

            In this case, the
patient has microcornea and also irregular appearance of cornea (superiorly
located bleb) which is likely due to the surgeries before. So that, O2
Optix custom lenses were chosen because of its smaller diameter  and also higher range of sphere power which ranging
from +20.00 D to -20.00 D. However, in
pediatric aphakia, there is a thick central portion of high plus power lenses which
inherently reduced oxygen permeability and therefore resulting in several
corneal and conjunctival complications. These lenses might be damaging to the globe
of paediatric patient that is small and still developing. Therefore, hard lenses
(RGP) can be among the excellent choices for treatment of pediatric aphakia.
Due to paediatric ocular condition which consists of small corneal diameter, a
narrow lid fissure with tense lids, RGP lenses could be the best option. RGP
lenses are the healthiest lens for the small developing eye when compared with
other types of contact lenses. It requires daily care which is simpler than
other types of contact lens and thus providing great convenience for parents to
handle their aphakic child. However the major problems of wearing any types of
contact lenses are poor compliance with continual use.

             The patient developed aphakic glaucoma at
1-year-old and the patient had trabeculectomies for both eyes at 6 years of age.
Even after the surgery, the patient is still taking glaucoma medication and it
is also recommended for him to have
several evaluations for glaucoma to monitor any possible progression. It is
important because when the medical therapy unable to make the patient’s IOP lower
sufficiently, the patient is required to undergo another surgical intervention.

 

 

 

 

 

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