Posterior Capsular Outcomes of Pediatric Cataract Surgery With In-The-Bag Intraocular Lens Implantation

Abstract

AimTo investigate the change of posterior capsular outcomes of pediatric cataract surgery with primary in-the-bag intraocular lens (IOL) implantation.MethodsWe conducted a case series of pediatric cataract children who underwent cataract extraction with primary in-the-bag IOL implantation, posterior capsulorhexis or vitrectorhexis, and limited anterior vitrectomy at the Eye Hospital of Wenzhou Medical University between 2016 and 2019. Digital retro-illumination photographs of pediatric eyes were obtained at baseline and 6 months, 12 months, and the last visit postoperatively. Capsular outcomes of the posterior capsular opening area (PCOA) and lens reprolifration area at those time points were compared. Correlations between the PCOA and influential factors, such as age at surgery, axial growth, and follow-up duration, were analyzed. The study was registered at register.clinicaltrials.gov (NCT04803097).ResultsData of 23 patients (27 eyes) were used in the final analysis. During follow-up, the PCOA enlarged at a rate of 0.29–0.32 mm2/month during the first six months postoperatively and 0.05–0.08 mm2/month over the next 1–2 years. Six months postoperatively, the PCOA enlargement statistically and positively correlated with the follow-up duration and axial growth. The area of lens reprolifration was 0.46 ± 1.00 mm2 at six months postoperatively and then remained stable.ConclusionThe PCOA enlarged rapidly within the first six months after the pediatric cataract surgery with primary IOL implantation. Six months postoperatively, the enlargement of PCOA was positively correlated with follow-up duration and axial growth. Posterior capsulorhexis or capsulectomy should be performed with a diameter of 3.0 to 4.0 mm for good visual axis transparency and the protection of in-the-bag IOL.

Reopening the capsular bag by removing the capsular proliferative membrane to enable secondary in-the-bag IOL implantation in pediatric aphakic eyes

“…For primary cataract extraction, uncomplicated lens aspiration after anterior continuous curvilinear capsulorhexis combined with posterior continuous curvilinear capsulorhexis and limited anterior vitrectomy was performed in all patients. Based on the findings from previous studies, 21,22 an anterior capsular opening diameter (ACOD) of 4.0-5.0mm and a posterior capsular opening diameter (PCOD) of 3.0-4.0mm were Intentionally performed to keep the transparency of visual axis. For secondary IOL implantation, the following surgical procedures were performed: After general anesthesia with endotracheal intubation, a 2.2-mm scleral tunnel incision was made (Figure 1, A-G).…”

Surgical challenges of posterior optic capture in pediatric cataract surgery

“…Even after meticulous surgery including anterior capsulorhexis (ACCC), and implantation of an acrylic hydrophobic intraocular lens (IOL), high capsular opacification rates have been reported across the globe. [ 1 2 3 4 5 ] Primary posterior capsulotomy (PPC) and anterior vitrectomy (AV) are customary as the anterior hyaloid phase acts as a scaffold for the lens epithelial cells to migrate. This reduces the rate of PCO, but there are reports that it still occurs in 17–60% of the patients after PPC and vitrectomy.…”