Analysis of the surgical treatment of posterior lenticonus associated with congenital cataract

Abstract

Aim. The objective of the present study was to analyze the results of the surgical treatment of the children presenting with posterior lenticonus associated with congenital cataract. Materials and methods. The total of 8 children (8 eyes) with posterior lenticonus enrolled in this study accounted for 6.5% of all cases of congenital cataract treated at the “Excimer” Eye Center during the period from 2003 to 2015. The age of the patients varied from 0.2 to 15 (mean 8.1±3.8) years. Preoperatively, the uncorrected visual acuity was estimated to be 0.11±0.1 (0.01 - 0.3), with the best corrected visual acuity being 0.15±0.13 (range: 0.01 - 0.4). Lensectomy was performed under general anesthesia by means of the incision technology (1.8 and 2.2 mm) with the use of the Millenium, Stellaris microsurgical system (Bausch and Lomb, USA) and the Infinity system (Alcon, USA). In all the cases, different IOL models (Alcon, USA) were implanted; in four cases, the toric intraocular lenses were used. Results. In all the patients with posterior lenticonus and congenital cataract, the “dry” aspiration of the lens was performed. The distinctive features of posterior capsulorhexis included the use of two viscoelastic materials, viz. heavy Healon GV applied over the intraocular lens and ProVisc applied under the intraocular lens in the form of a “layer cake”. Thereafter, posterior capsulorhexis and vitrectomy were done. The lens was implanted into the capsular bag (n = 6) and into the ciliary sulcus (n = 2) with the anterior and posterior “optic capture”; the edges of the optical hole were placed behind the capsulorhexis hole. In the cases of the initial posterior capsular defect (n = 3), we performed vitreorhexis and vitrectomy followed by intraocular lens implantation. The best corrected visual acuity increased from 0.15 before the operation to 0.72 after surgery, with astigmatism being reduced from 2.3±0.9 to 1.6±065 diopters (overall astigmatism for the entire group) and from 1.81±0.46 to 0.56±0.56 diopters for the subgroup treated by means of toric IOL implantation. The patients remained under the observation during the follow-up period of more than 36 months. Conclusion. Lensectomy followed by intraocular lens implantation used for the treatment of the children presenting with posterior lenticonus and congenital cataract is the efficient method for the management of this combined pathology. Such features of the surgical technique as “dry” aspiration of the lens mass, posterior capsulorhexis, anterior vitrectomy, and optical capture taken together make it possible to achieve the favourable and stable functional outcome of the treatment.