Diagnosis and management of congenital cataract with preexisting posterior capsule defect

Purpose: To establish and evaluate the diagnostic signs, intraoperative performance, and postoperative outcomes in children with congenital cataract with a preexisting posterior capsule defect (PCD). Setting: 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%). Conclusion: Establishing the diagnostic signs of PCD with the eye fully dilated and carefully planning the surgery produced satisfactory technical and visual outcomes.