A retrospective comparison of techniques to prevent secondary cataract formation following posterior chamber intraocular lens implantation in infants and children.
OBJECTIVE
To determine the effect of various methods of managing the posterior capsule and anterior vitreous on the rate of posterior capsular opacification in children implanted with posterior chamber intraocular lenses (PC IOL).


METHODS
We reviewed the charts of 20 eyes of 15 children (1.5-12 years) who underwent primary cataract surgery with PC IOL in the last 5 years. The posterior capsule and anterior vitreous were managed in a variety of ways: in 5 eyes the posterior capsule was left intact, and 15 eyes underwent posterior continuous curvilinear capsulorhexis (PCCC)-nine cases without and 6 with anterior vitrectomy. In 8 eyes posterior optic capture was performed, 3 with and 5 without vitrectomy. The follow-up ranged from 1 to 4.5 years (mean: 2 years).


RESULTS
Visually significant secondary cataract developed in all 5 eyes with intact posterior capsules and in the 4 eyes that underwent PCCC without vitrectomy and without posterior optic capture (i.e., the optic was left in the capsular bag). The optical axis remained clear in all 6 eyes that underwent PC IOL implantation with vitrectomy (with or without posterior optic capture). Initially, all optic capture cases without vitrectomy also remained clear, but after 6 months 4 out of 5 developed opacification.


CONCLUSIONS
In this series posterior capsulorhexis with anterior vitrectomy was the only effective method of preventing or delaying secondary cataract formation in infants and children.
Koch
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Cullen Eye Institute, Baylor College of Medicine, Department of Ophthalmology, Houston, Texas, USA.
Kohnen
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D019923:Capsulorhexis; D002386:Cataract / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007903:Lens Capsule, Crystalline / Q000473:pathology*; D019654:Lens Implantation, Intraocular / Q000009:adverse effects*; D007910:Lenses, Intraocular; D008297:Male; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D012189:Retrospective Studies; D014821:Vitrectomy
D019904:Polymethyl Methacrylate