title: In-the-bag intraocular lens placement via secondary capsulorhexis with radiofrequency diathermy in pediatric aphakic eyes.
abstract: Pediatric ophthalmologists increasingly recognize that the ideal site for intraocular lens (IOL) implantation is in the bag for aphakic eyes, but it is always very difficult via conventional technique. We conducted a prospective case series study to investigate the success rate and clinical outcomes of capsular bag reestablishment and in-the-bag IOL implantation via secondary capsulorhexis with radiofrequency diathermy (RFD) in pediatric aphakic eyes, in which twenty-two consecutive aphakic pediatric patients (43 aphakic eyes) enrolled in the Childhood Cataract Program of the Chinese Ministry of Health were included. The included children underwent either our novel technique for secondary IOL implantation (with RFD) or the conventional technique (with a bent needle or forceps), depending on the type of preoperative proliferative capsular bag present. In total, secondary capsulorhexis with RFD was successfully applied in 32 eyes (32/43, 74.4%, age 5.6±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved in 30 eyes (30/43, 70.0%), but in the remaining 2 eyes (2/32, 6.2%) the IOLs were implanted in the sulcus with a capsular bag that was too small. Secondary capsulorhexis with conventional technique was applied in the other 11 eyes (11/43, 25.6%, age 6.9±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved only in 3 eyes(3/43, 7.0%), and the IOLs were implanted in the sulcus in the remaining 8 eyes. A doughnut-like proliferative capsular bag with an extensive Soemmering ring (32/43, 74.4%) was the main success factor for secondary capsulorhexis with RFD, and a sufficient capsular bag size (33/43, 76.7%) was an additional factor in successful in-the-bag IOL implantation. In conclusion, RFD secondary capsulorhexis technique has 70% success rate in the capsular bag reestablishment and in-the-bag IOL implantation in pediatric aphakic eyes, particularly effective in cases with a doughnut-like, extensively proliferative Soemmering ring.
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors: Lixia
authors: L
authors: Luo
authors: Haotian
authors: H
authors: Lin
authors: Weirong
authors: W
authors: Chen
authors: Chunxiao
authors: C
authors: Wang
authors: Xinyu
authors: X
authors: Zhang
authors: Xiangchen
authors: X
authors: Tang
authors: Jianping
authors: J
authors: Liu
authors: Nathan
authors: N
authors: Congdon
authors: Jingjing
authors: J
authors: Chen
authors: Zhuoling
authors: Z
authors: Lin
authors: Yizhi
authors: Y
authors: Liu
mesh_terms: D001036:Aphakia, Postcataract / Q000473:pathology / Q000601:surgery*; D019923:Capsulorhexis / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003972:Diathermy / Q000379:methods; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000379:methods; D008297:Male
references: J Cataract Refract Surg. 1988 Nov;14(6):673-6
references: 3230526
references: Jpn J Ophthalmol. 2009 May;53(3):275-7
references: 19484451
references: Ophthalmology. 2012 Dec;119(12):2463-70
references: 22921386
references: J Cataract Refract Surg. 2012 May;38(5):739-42
references: 22520301
references: Indian J Ophthalmol. 1995 Dec;43(4):159-76
references: 8655194
references: Am J Ophthalmol. 2010 Feb;149(2):245-252.e2
references: 19896636
references: J Cataract Refract Surg. 1997;23 Suppl 1:641-4
references: 9278818
references: Klin Monbl Augenheilkd. 1984 May;184(5):442-4
references: 6748545
references: J Cataract Refract Surg. 2008 Aug;34(8):1246-9
references: 18655972
references: Ophthalmology. 2003 Apr;110(4):840-59
references: 12689913
references: J AAPOS. 1999 Dec;3(6):350-5
references: 10613579
references: Curr Opin Ophthalmol. 2010 Jan;21(1):55-9
references: 19855277
references: J Pediatr Ophthalmol Strabismus. 2006 May-Jun;43(3):143-51; quiz 165-6
references: 16761634
references: Graefes Arch Clin Exp Ophthalmol. 2013 Jan;251(1):309-14
references: 22411128
references: Zhonghua Yan Ke Za Zhi. 2011 Apr;47(4):298-302
references: 21612677
references: J Cataract Refract Surg. 2010 May;36(5):771-7
references: 20457368
references: J Cataract Refract Surg. 1998 Jun;24(6):870-1
references: 9642604
references: Invest Ophthalmol Vis Sci. 1991 Jun;32(7):2155-9
references: 2055707
references: Ophthalmology. 2010 Dec;117(12):2278-86
references: 20561685
references: Br J Ophthalmol. 1994 May;78(5):392-6
references: 8025075
references: Br J Ophthalmol. 2000 Oct;84(10):1142-6
references: 11004100
references: Jpn J Ophthalmol. 1997 Mar-Apr;41(2):98-100
references: 9152812
references: Am J Ophthalmol. 1997 Jan;123(1):24-30
references: 9186093
references: J Cataract Refract Surg. 2009 Apr;35(4):720-4
references: 19304095