[Secondary cataract in aphakic children (author's transl)]

Extracapsular extraction of infantile cataract often leads to the development of secondary cataract. The object of this paper is to describe conditions leading to secondary cataract. Between 1960 and 1976, 251 children up to 12 years of age with bilateral congenital cataract were treated and followed up. Surgery was performed on 305 eyes (171 children). The total number of surgical interventions amounted to 707. In 125 cases, the occurrence of secondary cataract necessitated a second operation. Only through the posterior capsulotomy we were able to provide permanently clear optic media. In 85% of the cases with primary intact posterior capsules a secondary cataract operation was necessary within four years; in infants secondary cataract developed especially quickly. In 68 cases capsulotomy was accomplished during the primary surgical intervention. -- Traumatically induced aphakias were also investigated. In 441 cases with perforating injuries, 221 cases presented with considerable damage to the lens. Because of further complications a functional aphakia could only be achieved in 77 cases. Secondary cataract surgery was performed in 40 cases. -- The risk of late complications increases with insufficient application of atropine in the postoperative period, thereby inducing the formation of posterior synechiae. In the few cases where retinal detachment was observed, a vitreous prolapse into the anterior chamber, with the appearance of anterior synechias, was always present. -- Our observations led us to the following conclusions: Secondary cataract is an unavoidable consequence in cases where the posterior capsule remains intact. Since the preservation of an intact posterior capsule should remain the goal of the first intervention, the invariable occurrence of the secondary cataract should not be looked upon as a complication but rather as an inevitable condition to be treated in a mandatory second operation.