Incidence of chronic glaucoma, retinal detachment and secondary membrane surgery in pediatric aphakic patients

The eyes of 392 consecutive childhood cataract aspiration procedures were analysed for frequency of the development of chronic glaucoma and retinal detachment and the performance of secondary membrane surgery. Three different modifications of the aspiration procedure were employed: the standard needle and syringe procedure leaving the posterior capsule intact (304 eyes), rotoextraction with small opening of the posterior capsule (34 eyes) and Ocutome aspiration with wide excision of the posterior capsule (54 eyes). The mean postoperative follow-up was 5.5 years. Chronic glaucoma was found in 6.1% of the eyes. Coexisting ocular anomalies and retained lens cortex increased the risk for this complication. Retinal detachment was found in 1.5% of the cases. Coexisting ocular anomalies and uncontrolled vitreous disturbance increased the possibility of retinal detachment. Secondary membrane procedures were performed in 62% of the eyes in which the aspiration procedure left the posterior capsule intact, in nearly 12% of those in which the posterior capsule was minimally opened and in none of those which had the posterior capsule widely excised. The secondary membrane surgery itself appeared to increase the risk for both glaucoma and retinal detachment. The aspiration procedure with the lowest incidence for all three complications was the Ocutome aspiration with wide excision of the posterior capsule.