Elsevier

Ophthalmology

Volume 109, Issue 2, February 2002, Pages 324-327
Ophthalmology

When may the posterior capsule be preserved in pediatric intraocular lens surgery?

Presented in part at the American Academy of Ophthalmology annual meeting, Orlando, Florida, October 1999.
https://doi.org/10.1016/S0161-6420(01)00950-2Get rights and content

Abstract

Purpose

To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamber intraocular lens (PCIOL) implantation for cataract in childhood.

Design

Noncomparative case series.

Participants

Patients 1 to 13 years old who underwent cataract extraction with intent to preserve the posterior lens capsule and PCIOL implantation between January 1992 and December 1998 at a pediatric hospital.

Methods

Medical records were reviewed to determine the frequency and timing of posterior capsule opacification (PCO) after PCIOL surgery with preservation of an intact posterior capsule. Comparison of pseudophakic PCO rates for groups defined by age and several possible risk factors. Assessment of safety and efficacy for PPC with anterior vitrectomy performed through a limbal incision in cases where the posterior capsule could not be preserved.

Main outcome measures

Need for neodymium:yttrium-aluminum-garnet laser capsulotomy or surgical membranectomy to treat PCO.

Results

PCO occurred in 40% of 30 eyes with intact posterior capsule. Mean follow-up duration was 22 months for eyes that had PCO develop and 24 months for those in which the posterior capsule remained clear. Laser capsulotomy was required for 64% of 14 eyes in the 1- to 6-year-old age range but for only 19% of 16 in the 6- to 13-year-old range (P < 0.05). Mean time from surgery to PCO was 7 months for the younger group and 13 months for the older group. A need for repeated capsulotomy (one eye) or membranectomy with anterior vitrectomy (two eyes) was found only in the younger age group. There was no association of PCO with trauma history, cataract type, residual lens cortex, IOL position, or postoperative fibrin clot. Final vision was possibly compromised as a result of PCO in one eye with amblyopia. None of 24 eyes in which PPC with anterior vitrectomy was performed out of intraoperative necessity before primary PCIOL implantation had secondary opacification develop. No reduction in postoperative vision was attributable to PPC.

Conclusions

PPC seems to be advisable for children less than 6 years old when cataract extraction with PCIOL implantation is performed. Preservation of the posterior capsule remains appropriate for older children with pseudophakia.

Section snippets

Patients and methods

We reviewed medical records of all 54 children aged 1 to 13 years who underwent cataract extraction with IOL implantation (bilateral in 4 cases) performed by one of the authors (MJG or MBM, both experienced pediatric cataract surgeons), between January 1992 and December 1998.

Surgical technique evolved over time and differed slightly between the two surgeons but in general involved automated vitrector anterior capsulotomy and lens nucleus and cortical aspiration, followed by PCIOL implantation

Results

Thirty eyes of 28 patients met our criteria for inclusion in analysis of PCO rate after pediatric PCIOL implantation with preservation of the posterior capsule. Mean patient age at surgery in this group was 7.3 years. Postoperative follow-up ranged from 6 to 68 months, with a mean of 23 months.

Overall, 12 eyes (40%) developed PCO and underwent laser capsulotomy. The interval from surgery to documentation of significant PCO ranged from 1 to 26 months, with a mean of 9 months. Mean follow-up

Discussion

The overall frequency of PCO in our series of 30 eyes that underwent cataract extraction with PCIOL implantation in childhood was a relatively modest 40%, similar to that expected in adults.5 Numerous other authors6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 have reported PCO rates after pediatric IOL surgery ranging from less than 50%6, 11, 13, 17 to greater than 80%.10, 15, 16, 19 The reasons for this variability are not apparent. More frequent PCO has been observed in series with

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  • Revisiting secondary capsulotomy for posterior capsule management in pediatric cataract surgery

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Supported in part by an unrestricted grant to the Department of Ophthalmology, Northwestern University, from Research to Prevent Blindness, New York, New York.

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