Visual results of lens-sparing vitreoretinal surgery in infants

Lens removal is routinely performed when vitreoretinal surgery is done in infant eyes. We performed vitreous surgery in nine infants (10 eyes) without removing the crystalline lens. Surgery was done to correct vitreoretinal pathology involving the macula. Indications for surgery included: 1) tractional retinal detachment secondary to retinopathy of prematurity, familial exudative vitreoretinopathy, or congenital retinal folds; and, 2) nonclearing preretinal hemorrhage secondary to shaken-baby syndrome. Surgical objectives were achieved in all cases. Postoperatively, 8 of 10 eyes showed no evidence for lens opacification with a median follow-up period of 8 1/2 months (range, 5 to 19 months). Two eyes with retrolental adhesions due to stage 5 retinopathy of prematurity developed progressive cataracts and light perception vision. Six of seven eyes without lens opacity had vision of 20/2400 or better (median = 20/800) as measured by Teller acuity methods. Lens-sparing surgery may be performed with favorable anatomic and functional results in eyes with vitreoretinal disease posterior to the equator. Lens preservation may optimize optical rehabilitation and stimulation of the developing visual system.