Posterior vertical capsulotomy with optic entrapment of the intraocular lens in congenital cataracts--prevention of capsule opacification.
OBJECTIVE
To present a modified surgical technique for preventing posterior capsule opacification (PCO) in children with congenital cataracts and to evaluate its long-term efficacy.


METHODS
Department of Ophthalmology, Medical University of Southern Africa, Medunsa, South Africa.


METHODS
Anterior and posterior vertical capsulotomy, with optic entrapment of the intraocular lens (IOL) by maintaining the anterior hyaloid, was performed in 68 cataractous eyes of children aged 2 months to 8 years (mean 3 years, 1 month). The posterior capsule was evaluated for at least 5 years for secondary opacification, IOL position, pigmentary deposits on the IOL optic, and the presence of synechias.


RESULTS
Sixty-eight eyes maintained a clear visual axis for 5 to 12 years (mean 9 years, 1 month) postoperatively. No secondary procedure was necessary. In all eyes, the IOL remained well centered and entrapped.


CONCLUSIONS
Posterior capsulotomy with optic entrapment of the IOL proved to be a safe and efficient surgical procedure for preventing PCO in children with congenital cataracts. Uniting the anterior and posterior capsule in front of the IOL limits the proliferation and migration of Elschnig pearls. An intact anterior hyaloid does not induce capsule opacification in association with optic entrapment; therefore, a vitrectomy is not indicated even in infants under age 5 years. Clear visual axis, centered IOL, and intact vitreous were achieved in this series; this enables a promising long-term prognosis for binocular visual development, especially because surgery was performed early.
Department of Ophthalmology, Medical University of Southern Africa, Medunsa, South Africa. mgrieshaber@uhbs.ch
Matthias C
MC
Grieshaber
Ané
A
Pienaar
Robert
R
Stegmann
D002386:Cataract / Q000151:congenital* / Q000209:etiology / Q000517:prevention & control*; D002387:Cataract Extraction / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007903:Lens Capsule, Crystalline / Q000473:pathology / Q000601:surgery*; D019654:Lens Implantation, Intraocular / Q000009:adverse effects / Q000379:methods*; D007910:Lenses, Intraocular; D011183:Postoperative Complications / Q000517:prevention & control*; D014792:Visual Acuity