Influence of posterior capsule abnormalities in pediatric cataract surgery
Yichao Ding1, Jing Zhang, Yusen Huang
1From the Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China (Ding, Zhang, Huang); State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China (Ding, Zhang, Huang); School of Ophthalmology, Shandong First Medical University, Qingdao, Shandong, China (Ding, Zhang, Huang).
Insights
Posterior capsule abnormalities (PCAs) are common in pediatric cataract surgery, complicating procedures and sometimes requiring anterior vitrectomy (AV). Careful management allows successful intraocular lens (IOL) implantation in Berger space.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Cataract Surgery
Background:
- Pediatric cataracts present unique surgical challenges.
- Posterior capsule abnormalities (PCAs) are a significant concern during pediatric cataract surgery.
- Managing PCAs influences intraocular lens (IOL) implantation outcomes.
Purpose of the Study:
- To outline the management strategies for posterior capsule abnormalities (PCAs) in pediatric cataract cases.
- To assess the impact of PCAs on intraocular lens (IOL) optic implantation in Berger space during pediatric cataract surgeries.
Main Methods:
- Retrospective case series analysis of pediatric cataract surgeries.
- Video analysis of surgical interventions, including PCAs and complications.
- Evaluation of primary posterior continuous curvilinear capsulorhexis (PCCC) success rates and anterior vitrectomy (AV) necessity.
- Assessment of IOL optic capture feasibility in Berger space.
Main Results:
- PCAs were identified in 33.5% of pediatric cataract surgeries (76/227 eyes), particularly in unilateral cases.
- Primary PCCC success was 44.7% (34/76 eyes), with unplanned AV required in 47.4% (36/76 eyes).
- Successful IOL optic implantation in Berger space was achieved in 63.2% (48/76 eyes).
Conclusions:
- PCAs are frequently encountered in pediatric cataract surgery, especially unilateral cases.
- The presence of PCAs can complicate PCCC and necessitate AV.
- Skilled surgical technique enables successful IOL optic implantation in Berger space despite PCAs.
Purpose:
To report how to manage posterior capsule abnormalities (PCAs) in pediatric cataracts and evaluate the influence of PCAs during intraocular lens (IOL) optic implantation in Berger space surgeries.
Setting:
Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.
Design:
Retrospective case series study.
Methods:
Pediatric patients with PCAs who underwent cataract surgery were evaluated. A video-based analysis of the surgical interventions included the type of crystalline lens opacification, types and management of PCAs, complications during primary posterior continuous curvilinear capsulorhexis (PCCC), need for anterior vitrectomy (AV), and feasibility of IOL optic capture.
Results:
There were 227 pediatric cataract surgeries performed during the study period, and 76 eyes of 66 children with PCAs were evaluated (33.5%, 76/227). Unilateral cataract with PCAs were found in 50 eyes (22.0%, 50/227) and bilateral were found in 26 eyes (11.5%, 26/227). The PCAs were posterior capsule plaque (19.8%, 45/227), posterior capsule defect (6.2%, 14/227), posterior lenticonus (3.1%, 7/227), and persistent fetal vasculature (4.4%, 10/227). In the PCA cases, primary PCCC was successful in 44.7% of the cases (34/76). An unplanned AV during the surgeries was performed in 47.4% (36) of the 76 eyes. IOL optic implantation in Berger space was achieved in 63.2% of the eyes (48/76).
Conclusions:
PCAs are often encountered during pediatric cataract surgeries, especially in unilateral cases. The presence of PCAs may complicate a primary PCCC procedure, resulting in an unplanned AV in some cases. IOL optic implantation in Berger space can also be performed fortunately with well-designed and skilled operation.
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