When may the posterior capsule be preserved in pediatric intraocular lens surgery?☆
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
References (23)
- et al.
Management of infantile cataracts
Am J Ophthalmol
(1967) Posterior lens capsulectomy in primary cataract surgery in children
Ophthalmology
(1983)- et al.
Visual outcomes after surgery for unilateral cataract in children more than two years oldposterior chamber intraocular lens implantation versus contact lens correction for aphakia
J AAPOS
(1998) - et al.
Pseudophakia for traumatic cataracts in children
Ophthalmology
(1993) - et al.
Cataract surgery and intraocular lens implantation in children
Am J Ophthalmol
(1995) - et al.
Outcome and complications of intraocular lenses in children with cataract
J Cataract Refract Surg
(1996) - et al.
Results of a prospective evaluation of three methods of management of pediatric cataract
Ophthalmology
(1996) - et al.
Epilenticular lens implantation versus extracapsular cataract extraction and lens implantation in children
J Cataract Refract Surg
(1997) - et al.
Capsular management and refractive error in pediatric intraocular lenses
Ophthalmology
(1997) - et al.
Results of bilateral cataract extraction with posterior chamber intraocular lens implantation in children
Ophthalmology
(1997)
Posterior capsulectomy in pediatric cataract surgerythe necessity of a choice
Ophthalmology
Cited by (79)
Osmotically induced removal of lens epithelial cells to prevent PCO after pediatric cataract surgery: Pilot study to assess feasibility
2019, Journal of Cataract and Refractive SurgeryCataract surgery in children with non-infectious uveitis: Review of current practices in France
2019, Journal Francais d'OphtalmologieLong-Term Outcome of Nd:YAG Laser Posterior Capsulotomy in Children: Procedural Strategies and Visual Outcome
2019, American Journal of OphthalmologyRevisiting secondary capsulotomy for posterior capsule management in pediatric cataract surgery
2016, Journal of AAPOSCitation Excerpt :Nonetheless, leaving the posterior capsule intact is possible at any age, particularly for children with reliable follow up to evaluate for PCO and treat as needed to prevent amblyopia. The principle criticism of leaving the posterior capsule intact is that the rate of PCO formation is unacceptably high and that YAG capsulotomy is ineffective to treat this amblyogenic complication.7,11,12,17 Hutcheson and colleauges18 reported a recurrence rate of 57% after YAG capsulotomy, and Atkinson and Hiles19 reported a recurrence rate of 28%.
Primary posterior capsulotomy in femtosecond laser–assisted cataract surgery: In vivo spectral-domain optical coherence tomography study
2016, Journal of Cataract and Refractive SurgeryCataracts
2017, The Lancet
- ☆
Supported in part by an unrestricted grant to the Department of Ophthalmology, Northwestern University, from Research to Prevent Blindness, New York, New York.