Clinical Characteristics and Surgical Safety in Congenital Cataract Eyes with Three Pathological Types of Posterior Capsule Abnormalities

Abstract

Purpose. To observe the clinical characteristics of 3 pathological types of posterior capsule abnormalities (PCAs) in congenital cataracts (CCs) and evaluate the surgical safety in these eyes. Methods. This study involved 239 children (367 eyes) with CC who underwent cataract surgery at the Eye Hospital of Wenzhou Medical University. All surgery videos were collected for detailed reviews. Intraoperative and postoperative complications (within 3 months) were all recorded. Results. The 3 pathological types of PCAs, namely, persistent fetal vasculature (PFV), posterior capsule defect (PCD), and posterior lenticonus (PLC), presented in 129 (35.1%) CC eyes, while 238 (64.9%) eyes were recorded as CC without PCA. The percentages of PFV, PCD, and PLC were 10.9%, 26.7%, and 5.4% in CC eyes (n = 367), respectively. The most common concomitant of PFV eyes was PCD (42.5%), and PFV was the most frequent (17.3%) one in PCD eyes. PLC was only associated with PFV (15%) and PCD (50%). The occurrence rates of surgical complications ranged from 0 to 5.4%, and no statistical difference was found between the eyes with and without PCA (all P>0.05). Conclusions. PFV, PCD, and PLC play a very important role in the CCs. The effect of fetal vessels in PFV eyes might be an abnormally strong attachment on the posterior capsule, leading to PLC and PCD. Even in PCA patients, severe surgical complication can also be avoided with well-designed and skilled operation. This trial is registered with NCT03905044 at http://ClinicalTrials.gov.

Influence of posterior capsule abnormalities in pediatric cataract surgery

“… 22 However, in the study by Ding et al, the rates of occurrence of PFV, posterior capsule defect, and posterior lenticonus were 10.9%, 26.7%, and 5.4% in congenital cataract eyes, respectively. 16 Likewise, in our study, the patients had a higher proportion of posterior capsule defects and lower proportion of posterior lenticonus. The smaller proportion of children with these 3 PCAs in our study may be due to the higher proportion of children with PCPs.…”

“…This is similar to another Chinese study where the PCA occurrence rate was 35.1% during surgery. 16 PCP was the most common type in PCAs. PCP is a white, dense opacity adherent to the internal surface of posterior lens capsules.…”

Congenital cataract – clinical and morphological aspects

“…The most significant changes were at the level of the posterior capsule. According to literature, thinning and bending of the posterior capsule can promote progressive destruction of the lens fibers and further formation of cataract [30,31]. We must say that the lens is a unique, complex structure made up of special cells and proteins whose alteration, genetically or environmentally induced, leads to visual disturbances, including cataract [32][33][34][35][36].…”

Classification of congenital cataracts based on multidimensional phenotypes and its association with visual outcomes

“…Our study suggests that posterior cataracts may be associated with a less favorable visual acuity prognosis. Clinically, cataracts involving the posterior capsule are associated with greater surgical difficulty and a higher risk of severe complications [33] , which may further impact visual acuity outcomes [34][35] . Therefore, ophthalmologists should exercise caution and prudence when devising surgical treatment plans for congenital cataracts that involve the posterior capsule.…”