Diagnosis and management of congenital cataract with preexisting posterior capsule defect.
OBJECTIVE
To establish and evaluate the diagnostic signs, intraoperative performance, and postoperative outcomes in children with congenital cataract with a preexisting posterior capsule defect (PCD).


METHODS
Iladevi Cataract & IOL Research Centre, Ahmedabad, India.


METHODS
This study evaluated 400 consecutive eyes that had congenital cataract surgery, of which 27 (20 children) had a confirmed preexisting PCD. Seven children had bilateral defects. The preoperative diagnostic signs of PCD under maximum pupil dilation included well-demarcated, thick defect margins; white dots on the posterior capsule; and white dots in the anterior vitreous that moved with the degenerated vitreous like a fish tail (fish-tail sign). Hydrodissection was not attempted. Bimanual irrigation/aspiration and 2-port anterior vitrectomy were performed. The mean follow-up was 17.9 months +/- 16.96 (SD).


RESULTS
The mean age of the 16 boys and 4 girls with a PCD was 21.98 +/- 33.33 months. Nineteen eyes (70.3%) had total white mature cataract. In 7 eyes (25.92%), the preexisting PCD was converted into a posterior capsulorhexis. Twenty eyes (74.07%) had an AcrySof MA30BA intraocular lens (IOL) implanted in the bag and 4 eyes (14.81%), in the sulcus. Three eyes (11.11%) were left aphakic. The visual axis remained clear in all eyes, and the IOL was well centered in 24 eyes (88.88%).


CONCLUSIONS
Establishing the diagnostic signs of PCD with the eye fully dilated and carefully planning the surgery produced satisfactory technical and visual outcomes.
Vasavada
Abhay R
AR
Iladevi Cataract & IOL Research Centre, Memnagar, Ahmedabad, India. shailad1@sancharnet.in
Praveen
M R
MR
Nath
Vandana
V
Dave
Kavita
K
D002386:Cataract / Q000151:congenital* / Q000175:diagnosis*; D002387:Cataract Extraction / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005124:Eye Abnormalities / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007903:Lens Capsule, Crystalline / Q000002:abnormalities* / Q000473:pathology; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D011446:Prospective Studies; D014792:Visual Acuity; D014821:Vitrectomy