Retrospective comparison of techniques to prevent secondary cataract formation after posterior chamber intraocular lens implantation in infants and children

Purpose: To determine the effect of various methods of managing the posterior capsule and anterior vitreous on the rare of posterior capsule opacification in pediatric eyes implanted with posterior chamber intraocular lenses (PC IOLs). Setting: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Methods: We reviewed the charts of 20 eyes of 15 children (aged 1.5 to 2 years) who had primary cataract surgery with PC IOL implantation during the past 5 years. The posterior capsule and anterior vitreous were managed in a variety of ways: In 5 eyes, the posterior capsule was left intact; in 15 eyes, a posterior continuous curvilinear capsulorhexis (PCCC) was performed-6 with and 9 without anterior vitrectomy; in 8 eyes, posterior optic capture was performed-3 with and 5 without vitrectomy. The follow-up ranged from 1 to 4.5 years (mean 2 years). Results: Visually significant secondary cataract developed in the five eyes with intact posterior capsules and in the four eyes that had PCCC without vitrectomy and without posterior optic capture (i.e., the optic was left in the capsular bag). The optical axis remained clear in the six eyes that had PC IOL implantation with vitrectomy (with or without posterior optic capture). Initially, all eyes that had optic capture without vitrectomy also remained clear, but after 6 months, four of five developed opacification. Conclusion: In this series, PCCC with anterior vitrectomy was the only effective method of preventing or delaying secondary cataract formation in infants and children.