title: When may the posterior capsule be preserved in pediatric intraocular lens surgery?
abstract: OBJECTIVE
  To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamber intraocular lens (PCIOL) implantation for cataract in childhood.
  
  
  METHODS
  Noncomparative case series.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Division of Ophthalmology, Department of Surgery, Children's Memorial Hospital, Northwestern University, Chicago, Illinois, USA.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Jensen
authors.forename: Surendra
authors.initials: S
authors.lastname: Basti
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Greenwald
authors.forename: Marilyn B
authors.initials: MB
authors.lastname: Mets
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002386:Cataract / Q000209:etiology* / Q000628:therapy; D002387:Cataract Extraction / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D053685:Laser Therapy; D007903:Lens Capsule, Crystalline / Q000473:pathology* / Q000601:surgery; D019654:Lens Implantation, Intraocular / Q000009:adverse effects*; D008297:Male; D019591:Pseudophakia / Q000150:complications; D012307:Risk Factors; D012449:Safety; D013997:Time Factors; D014792:Visual Acuity; D014821:Vitrectomy