In-the-bag secondary intraocular lens implantation in children

Surgery for congenital cataracts in early infancy usually includes a primary posterior capsulectomy and an anterior vitrectomy. Initially, most of these infants have aphakia after surgery. Over time, remaining equatorial lens epithelial cells produce new cortical fibers, resulting in a ring of cortex trapped between the lens equator and the fused anterior and posterior capsulectomy edges. A potential space is maintained between the anterior and posterior capsular leaflets. We describe a technique for placing a secondary intraocular lens (IOL) within the capsular bag.

Eight children, ranging in age from 11 months to 14 years, who originally had aphakia after cataract extraction were operated on with the intent to reopen the capsular bag and place an IOL in the bag.

Secondary in-the-bag IOL implantation was successfully completed in 7 of 8 children. This was accomplished by reopening the capsular bag 360 degrees at the edge of the fused anterior and posterior capsulectomy remnants, using the previously published vitrectorhexis technique. Residual cortical material was aspirated, and an IOL was placed within the capsular bag. In 1 child, aged 14 years, the capsular bag was reopened, but the lens was placed in the ciliary sulcus because the new anterior capsule edge could not be visualized for 360 degrees .

Placement of secondary IOLs within the capsular bag can be accomplished successfully for selected patients in the pediatric population. Surgeons operating on infantile cataracts without primary IOL placement can facilitate capsular IOL sequestration later by limiting the anterior and posterior capsulectomy to 4 to 5 mm and performing a generous anterior vitrectomy to help prevent secondary closure of the smaller capsulectomy.