[Secondary IOL implantation in aphakic children after early surgery for congenital cataracts]

The purpose of the study was to develop differentiated approach for secondary intraocular lens (IOL) implantation in children after congenital cataract extraction in infancy.

Secondary IOL implantation was performed in 42 children (56 eyes) aged from 1.5 to 6 years who underwent congenital cataract surgery at the age of 2-10 months. A total of 19 children had unilateral involvement. In 14 cases of bilateral aphakia the implantation was performed on both eyes. In 9 children a single-step cataract extraction with unilateral IOL implantation was followed by a delayed IOL implantation on the previously operated contralateral eye. The posterior lens capsule was intact in 39 eyes, while in 17 it had various congenital defects. Capsule opacification was found in 34 eyes, either congenital (8 eyes) or acquired (26 eyes). Along with conventional ophthalmic assessment, other examinations that are essential for IOL power calculation (autorefractomentry and ultrasound biomicroscopy - UBM) and posterior chamber assessment (UBM) were performed. The injection of either monoblock (Acrysof SN60 WF; SN60AT, (Alcon)) or tripartite (Acrysof MA60AC (Alcon)) intraocular lens was done through a tunnel corneal incision. Monitoring period varied from 6 months to 4 years.

The choice of surgical tactics, IOL model and fixation method depended on the integrity of the capsular bag, condition of the posterior capsule, and presence of iridocapsular adhesions. Intracapsular IOL implantation was performed in 28.2% of eyes with intact posterior capsule and in 11.8% of eyes with the capsule defects. In three eyes with no capsular support IOLs were sutured to the sclera. In most children (76.8%) posterior chamber reconstruction had to be performed due to iridocapsular adhesions.

The choice of surgical tactics and the extent of surgical intervention for the purpose of secondary IOL implantation in children who underwent congenital cataract extraction are individual and depend on the integrity of the capsular bag.