Pediatric cataract surgery and intraocular lens implantation techniques: a laboratory study

The use of primary posterior capsulectomy and anterior vitrectomy during pediatric intraocular lens (IOL) implantation has been advocated as a means of preventing the development of posterior capsule opacification. In this study, we used pediatric eyes obtained postmortem to compare two different sequences in the surgical procedure: (1) anterior capsulectomy, lens substance removal, primary posterior capsulectomy with anterior vitrectomy, and IOL implantation in the capsular bag; (2) anterior capsulectomy, lens removal, IOL implantation in the capsular bag, and primary posterior capsulectomy with anterior vitrectomy. Both sequences could be safely performed in the laboratory setting while maintaining stable capsular fixation of the IOL. Placing the IOL in the capsular bag was easier when the posterior capsule was intact (sequence 2). However, both techniques appear feasible for clinical use. Surgeons not familiar with mechanized primary posterior capsulectomy can gain clinically relevant experience by operating on pediatric autopsy eyes in a laboratory setting.