Anterior vitreo‐lenticular interface in children

Abstract

SummaryTo demonstrate that developmental cataract involves more than opacification of the lens: the anterior vitreo‐lenticular interface plays an important role in the surgical approach.All babies and children operated for congenital cataract since 2004 using the bag‐in‐the‐lens technique, which requires both anterior and posterior capsulorhexis, independently of the presence of persistant hyperplastic primary vitreous or fetal vasculature.By reviewing the surgical video's the relationship between anterior hyaloid and posterior capsule, defining Berger's space, shows a large variety of anatomical particularities. It is possible to carefully dissect these structures in an attempt to reduce anterior vitrectomy to a minimum. Bridges between anterior hyaloid and posterior capsule can easily be ruptured by ocular viscoelastic dissection.Better knowledge of the anterior vitreo‐lenticular interface would largely increase the surgical outcome of developmental cataract. Currently medical devices allowing to visualize this interface prior to surgery are lacking. Dissection of primary vitreous from posterior capsule is time‐consuming but feasible. Chemicals, like microplasmin, may be of some benefit for the cataract surgeon to optimize the separation.