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Anterior Vitrectomy for Recurrent
Secondary Cataract in Infants
Wido M. Budde, M.D. Jost B. Jonas, M.D., and Gabriele
C. Gusek-Schneider, M.D.
Department of Ophthalmology, Friedrich-Alexander University
Erlangen-Nürnberg, Erlangen, Germany
Corresponding author: Dr. W. Budde, Universitäts-Augenklinik, Schwabachanlage
6, D-91054 Erlangen, Germany; Phone: +49-9131-8533001; Fax: +49-9131-8534436;
E-Mail: Wido.Budde@augen.med.uni-erlangen.de
Background
Treatment of cataract in children has long been controversial concerning
the implantation of intraocular lenses and treatment of opacifications
of the posterior lens capsule (6). This study reports on recurrent opacifications
of the optical axis in eyes of children who underwent cataract operation
without performing transpupillary vitrectomy.
Patients
45-months old child was operated for congenital unilateral posterior
polar cataract in combination with a posterior lenticonus. A standard
procedure was applied including sclerocorneal tunnel, anterior capsulotomy,
irrigation and aspiration of the lens material, implantation of a posterior
chamber polymethylmetacrylate intraocular lens into the lens capsular
bag, and basal iridectomy at the 12 o`clock position. The posterior
lens capsule was left intact. Two months later, a posterior Nd-YAG laser
capsulotomy was performed in general anesthesia to remove a central
opacification of the posterior lens capsule. This procedure was repeated
two months later due to a re-proliferation of lens epithelial cells
onto the vitreous surface behind the intraocular lens. Within the next
six months, the optical axis re-opacified since lens epithelial cells
again formed a dense membrane on the anterior surface of the vitreous
body. Anterior vitrectomy was carried out using a limbal incision and
going through the basal iridectomy and the peripheral posterior lens
capsule at the 12 o`clock position into the vitreous cavity to remove
the hyloid body from the space behind the intraocular lens. After this
fourth intervention in general anethesia, the optical axis has remained
clear so far with a follow-up time of four years. Due to amblyopia,
visual acuity measures 20/200.
A second child presented with congenital
cataract in both eyes which were operated at the age of two weeks and
three weeks, respectively, with planned posterior capsulorhexis without
rupture or removing of the anterior hyaloid surface. Within the next
two months, transpupillary vitrectomy became necessary since in both
eyes, lens epithelial cells had migrated onto the intact anterior hyaloid
surface leading to a dense opacification of the optical axis. After
this procedure, the optical axes have remained clear so far in a follow-up
period of more than 2 years.
Conclusions
With the anterior hyaloid and the posterior surface of the intraocular
lens providing scaffold for lens epithelial cells to proliferate, repeated
Nd-YAG-laser capsulotomy after pediatric cataract surgery with implantation
of a posterior chamber intraocular lens does not always preclude opacification
of the visual axis, eventually necessitating anterior vitrectomy. It
confirms previous studies which reported on recurrent opacifications
of the visual axis after Nd-YAG laser capsulotomy in children, and which
showed that in some eyes, recurrent opacification of the visual axis
can be prevented only by extensive anterior vitrectomy, and not by posterior
capsulotomy alone (2,4,5). It suggests that posterior capsulotomy and
transpupillary vitrectomy, or, possibly, other techniques such as posterior
capsulorhexis with "capture" of the optical part of the intraocular
lens by the capsulorhexis edges, should be performed during pediatric
cataract surgery (1-3,6).
References
1. Basti S, Ravishenkar U, Gupta S (1996) Results of a prospective
evaluation of three methods of management of pdiatric cataracts. Ophthalmology
103: 713-720.
2. BenEzra D, Cohen E (1997) Posterior capsulectomy in pediatric cataract
surgery: the necessity of a choice. Ophthalmology 104: 2168-2174.
3. Gimbel H (1996) Posterior capsulorhexis with optic capture in pediatric
cataract and intraocular lens surgery. Ophthalmalogy 103: 1871-1875.
4. Morgan KS, Karcioglu ZA (1987) Secondary cataracts in infants after
lensectomies. J Pediatr Ophthalmol Strabismus 24: 45-48
5. Nishi O (1988) Fibrinous membrane formation on the posterior chamber
lens during the early postoperative period. J Cataract Refract Surg
14: 73-77.
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standard of care for children ? Ophthalmology 103: 1719-1720.
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