Capsular Opacification after Vitreous-Sparing Cataract Surgery in Children

Zusammenfassung

Hintergrund: Kapseltrübungen nach Hinterkammerlinsen-Implantation (HKL-Implantation) sind bei Kindern wegen Amblyopierisiko gefürchtet. Eine hintere Kapsulotomie mit vorderer Vitrektomie hat sich zur Reduktion der Nachstarbildung nach Kataraktoperation bewährt, geht hingegen mit einem erhöhten Risiko eines Sekundärglaukoms einher. Patienten und Methoden: Diese Studie untersuchte die Nachstarbildung in 73 Augen von afrikanischen Kindern, bei welchen eine HKL zwischen 1998 und 2001 unter Erhaltung des Glaskörpers implantiert wurde. Die Haptik der HKL wurde in allen Augen in den Kapselsack implantiert, davon die Optik in den Kapselsack ohne Kapsulotomie in 12, mit Kapsulotomie in 14 und in Kombination mit der Knopflochtechnik in 47 Augen. Resultate: Die Bildung von Elschnig-Perlen hing signifikant von der Knopflochtechnik (p < 0,001) und vom Alter des Kindes (p < 0,05), nicht aber von der Kapsulotomie (p = 0,084) und der Augenseite (p = 0,1) ab. Die Klarheit der Sehachse wurde signifikant von der Knopflochtechnik (p < 0,001), nicht aber von der Kapsulotomie beeinflusst. Schlussfolgerungen: Eine hintere Kapsulotomie verhindert keine zentrale Nachstarbildung nach Kataraktoperation und HKL-Implantation bei Kindern, wenn der Glaskörper erhalten wurde, außer in Kombination mit der Knopflochtechnik.

Abstract

Background: The aim of this study was to evaluate different methods of intraocular lens (IOL) implantation and posterior capsule management in the absence of vitrectomy with respect to visual axis opacification (VAO) in children. Patients and Methods: Seventy-three eyes of African children undergoing cataract extraction and IOL implantation between 1998 and 2001 were evaluated. In all eyes, the IOL haptics were placed in the bag and the vitreous was preserved. The IOL optic and posterior capsule were managed in the following 3 ways: The IOL optic was captured behind the posterior capsule in conjunction with posterior capsulotomy (PC) in 47 eyes (group 1). The IOL optic was implanted in the bag with PC in 14 eyes (group 2) and without PC in 12 eyes (group 3). Cox proportional hazard analysis and Kaplan-Meier survival curves were performed to evaluate the incidence of Elschnig pearls (EP) and VAO. Results: Elschnig pearls developed in 14.9 % of the patients in group 1, in 56.8 % in group 2 and in 91.7 % in group 3. The occurrence of EP depended significantly on optic capture (p < 0.001) and child’s age (p < 0.05), but not on PC (p = 0.084) and eye side (p = 0.1). The persistence of visual axis clarity depended significantly on optic capture (p < 0.001) but not on PC. Conclusions: In vitreous-sparing cataract surgery, posterior capsule opening does not effectively prevent VAO unless it is in conjunction with IOL optic capture.

Hinterkammerlinsen - pädiatrische Katarakt - Knopflochtechnik - Nachstarbildung - Kapseltrübungen

intraocular lens - paediatric cataracts - optic capture - capsular opacification - visual axis opacification

References

• 1 Alexandrakis G, Peterseim M M, Wilson M E. Clinical outcomes of pars plana capsulotomy with anterior vitrectomy in pediatric cataract surgery.  J Aapos. 2002;  6 163-167
• 2 Aslam T M, Dhillon B, Werghi N. et al . Systems of analysis of posterior capsule opacification.  Br J Ophthalmol. 2002;  86 1181-1186
• 3 Basti S, Ravishankar U, Gupta S. Results of a prospective evaluation of three methods of management of pediatric cataracts.  Ophthalmology. 1996;  103 713-720
• 4 Bender L, Spalton D J, Uyanonvara B. et al . POCOman: new system for quantifying posterior capsule opacification.  J Cataract Refract Surg. 2004;  30 2058-2063
• 5 BenEzra D, Cohen E. Posterior capsulectomy in pediatric cataract surgery: the necessity of a choice.  Ophthalmology. 1997;  104 2168-2174
• 6 Brady K M, Atkinson C S, Kilty L A. et al . Cataract surgery and intraocular lens implantation in children.  Am J Ophthalmol. 1995;  120 1-9
• 7 Buckley E G, Klombers L A, Seaber J H. et al . Management of the posterior capsule during pediatric intraocular lens implantation.  Am J Ophthalmol. 1993;  115 722-728
• 8 Dahan E. Intraocular lens implantation in children.  Curr Opin Ophthalmol. 2000;  11 51-55
• 9 Fenton S, O’Keefe M. Primary posterior capsulorhexis without anterior vitrectomy in pediatric cataract surgery: longer-term outcome.  J Cataract Refract Surg. 1999;  25 763-767
• 10 Ghosh B, Gupta A K, Taneja S. et al . Epilenticular lens implantation versus extracapsular cataract extraction and lens implantation in children.  J Cataract Refract Surg. 1997;  23 (Suppl 1) 612-617
• 11 Gimbel H V. Posterior capsulorhexis with optic capture in pediatric cataract and intraocular lens surgery.  Ophthalmology. 1996;  103 1871-1875
• 12 Gimbel H V. Posterior continuous curvilinear capsulorhexis and optic capture of the intraocular lens to prevent secondary opacification in pediatric cataract surgery.  J Cataract Refract Surg. 1997;  23 (Suppl 1) 652-656
• 13 Gimbel H V, DeBroff B M. Posterior capsulorhexis with optic capture: maintaining a clear visual axis after pediatric cataract surgery.  J Cataract Refract Surg. 1994;  20 658-664
• 14 Gimbel H V, Ferensowicz M, Raanan M. et al . Implantation in children.  J Pediatr Ophthalmol Strabismus. 1993;  30 69-79
• 15 Grieshaber M C, Pienaar A, Stegmann R. Posterior vertical capsulotomy with optic entrapment of the intraocular lens in congenital cataracts – prevention of capsule opacification.  J Cataract Refract Surg. 2005;  31 886-894
• 16 Guo S, Wagner R S, Caputo A. Management of the anterior and posterior lens capsules and vitreous in pediatric cataract surgery.  J Pediatr Ophthalmol Strabismus. 2004;  41 330-337; quiz 356 – 337
• 17 Hiles D A, Hered R W. Modern intraocular lens implants in children with new age limitations.  J Cataract Refract Surg. 1987;  13 493-497
• 18 Hosal B M, Biglan A W. Risk factors for secondary membrane formation after removal of pediatric cataract.  J Cataract Refract Surg. 2002;  28 302-309
• 19 Jensen A A, Basti S, Greenwald M J. et al . When may the posterior capsule be preserved in pediatric intraocular lens surgery?.  Ophthalmology. 2002;  109 324-327; discussion 328
• 20 Knight-Nanan D, O’Keefe M, Bowell R. Outcome and complications of intraocular lenses in children with cataract.  J Cataract Refract Surg. 1996;  22 730-736
• 21 Koch D D, Kohnen T. Retrospective comparison of techniques to prevent secondary cataract formation after posterior chamber intraocular lens implantation in infants and children.  J Cataract Refract Surg. 1997;  23 (Suppl 1) 657-663
• 22 Lambert S R, Drack A V. Infantile cataracts.  Surv Ophthalmol. 1996;  40 427-458
• 23 Mackool R J, Chhatiawala H. Pediatric cataract surgery and intraocular lens implantation: a new technique for preventing or excising postoperative secondary membranes.  J Cataract Refract Surg. 1991;  17 62-66
• 24 Malukiewicz-Wisniewska G, Kaluzny J, Lesiewska-Junk H. et al . Intraocular lens implantation in children and youth.  J Pediatr Ophthalmol Strabismus. 1999;  36 129-133
• 25 Nishi O, Nishi K. Preventing posterior capsule opacification by creating a discontinuous sharp bend in the capsule.  J Cataract Refract Surg. 1999;  25 521-526
• 26 Oliver M, Milstein A, Pollack A. Posterior chamber lens implantation in infants and juveniles.  Eur J Implant Refract Surg. 1990;  2 309-314
• 27 Parks M M. Posterior lens capsulectomy during primary cataract surgery in children.  Ophthalmology. 1983;  90 344-345
• 28 Plager D A, Lipsky S N, Snyder S K. et al . Capsular management and refractive error in pediatric intraocular lenses.  Ophthalmology. 1997;  104 600-607
• 29 Rabiah P K. Frequency and predictors of glaucoma after pediatric cataract surgery.  Am J Ophthalmol. 2004;  137 30-37
• 30 Raina U K, Gupta V, Arora R. et al . Posterior continuous curvilinear capsulorhexis with and without optic capture of the posterior chamber intraocular lens in the absence of vitrectomy.  J Pediatr Ophthalmol Strabismus. 2002;  39 278-287
• 31 Ram J, Apple D J, Peng Q. et al . Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part II: Choosing the correct haptic fixation and intraocular lens design to help eradicate posterior capsule opacification.  Ophthalmology. 1999;  106 891-900
• 32 Simons B D, Siatkowski R M, Schiffman J C. et al . Surgical technique, visual outcome, and complications of pediatric intraocular lens implantation.  J Pediatr Ophthalmol Strabismus. 1999;  36 118-124
• 33 Smith S R, Daynes T, Hinckley M. et al . The effect of lens edge design versus anterior capsule overlap on posterior capsule opacification.  Am J Ophthalmol. 2004;  138 521-526
• 34 Stager D R, Weakley Jr D R, Hunter J S. Long-term rates of PCO following small incision foldable acrylic intraocular lens implantation in children.  J Pediatr Ophthalmol Strabismus. 2002;  39 73-76
• 35 Tassignon M J, De Groot Jr V, Vrensen G F. Bag-in-the-lens implantation of intraocular lenses.  J Cataract Refract Surg. 2002;  28 1182-1188
• 36 Therneau T M, Grambsch P M. Modeling Survival Data. Berlin; Springer Verlag 2000
• 37 Vasavada A, Desai J. Primary posterior capsulorhexis with and without anterior vitrectomy in congenital cataracts.  J Cataract Refract Surg. 1997;  23 (Suppl 1) 645-651
• 38 Vasavada A R, Nihalani B R. Pediatric cataract surgery.  Curr Opin Ophthalmol. 2006;  17 54-61
• 39 Vasavada A R, Trivedi R H, Singh R. Necessity of vitrectomy when optic capture is performed in children older than 5 years.  J Cataract Refract Surg. 2001;  27 1185-1193
• 40 Vishwanath M, Cheong-Leen R, Taylor D. et al . Is early surgery for congenital cataract a risk factor for glaucoma?.  Br J Ophthalmol. 2004;  88 905-910
• 41 Whitley E, Ball J. Statistics review 4: sample size calculations.  Critical care (London, England). 2002;  6 335-341
• 42 Wilson M E. Intraocular lens implantation: has it become the standard of care for children?.  Ophthalmology. 1996;  103 1719-1720