Abstract
Pediatric ophthalmologists increasingly recognize that the ideal site for intraocular lens (IOL) implantation is in the bag for aphakic eyes, but it is always very difficult via conventional technique. We conducted a prospective case series study to investigate the success rate and clinical outcomes of capsular bag reestablishment and in-the-bag IOL implantation via secondary capsulorhexis with radiofrequency diathermy (RFD) in pediatric aphakic eyes, in which twenty-two consecutive aphakic pediatric patients (43 aphakic eyes) enrolled in the Childhood Cataract Program of the Chinese Ministry of Health were included. The included children underwent either our novel technique for secondary IOL implantation (with RFD) or the conventional technique (with a bent needle or forceps), depending on the type of preoperative proliferative capsular bag present. In total, secondary capsulorhexis with RFD was successfully applied in 32 eyes (32/43, 74.4%, age 5.6±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved in 30 eyes (30/43, 70.0%), but in the remaining 2 eyes (2/32, 6.2%) the IOLs were implanted in the sulcus with a capsular bag that was too small. Secondary capsulorhexis with conventional technique was applied in the other 11 eyes (11/43, 25.6%, age 6.9±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved only in 3 eyes(3/43, 7.0%), and the IOLs were implanted in the sulcus in the remaining 8 eyes. A doughnut-like proliferative capsular bag with an extensive Soemmering ring (32/43, 74.4%) was the main success factor for secondary capsulorhexis with RFD, and a sufficient capsular bag size (33/43, 76.7%) was an additional factor in successful in-the-bag IOL implantation. In conclusion, RFD secondary capsulorhexis technique has 70% success rate in the capsular bag reestablishment and in-the-bag IOL implantation in pediatric aphakic eyes, particularly effective in cases with a doughnut-like, extensively proliferative Soemmering ring.
Highlights
Pediatric cataract patients are commonly left aphakic after lens removal in early childhood, when surgery is performed in the first year of life.[1,2,3] Secondary intraocular lens (IOL) implantation is considered when an aphakic child is unable to tolerate contact lenses or glasses or when more functional vision without additional correction is desired. [4] the ciliary sulcus was the common site of implantation for many years, pediatric ophthalmologists increasingly recognize that the ideal site for IOL implantation is in the bag
(Figure 2), secondary capsulorhexis with radiofrequency diathermy (RFD) was successfully applied in 32 aphakic eyes (32/43, 74.4%, age 5.662.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were achieved in 30 eyes (30/32, 93.8%), and the IOLs were implanted in the sulcus with a capsular bag that was too small in the remaining 2 eyes (2/32, 6.2%)
Secondary capsulorhexis with conventional technique was applied in the other 11 aphakic eyes (11/43, 25.6%, age 6.962.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved only in 3 eyes (3/11, 27.3%, p,0.05 compared with cases via our novel technique), and the IOLs were implanted in the sulcus in the remaining 8 eyes (1 eye with unexpected tear in posterior capsule, 3 eyes with small capsular bag size and failure of capsular bag reestablishment in the other 4 eyes because of close adhesion of residual anterior-posterior-capsule)
Summary
Pediatric cataract patients are commonly left aphakic after lens removal in early childhood, when surgery is performed in the first year of life.[1,2,3] Secondary intraocular lens (IOL) implantation is considered when an aphakic child is unable to tolerate contact lenses or glasses or when more functional vision without additional correction is desired. [4] the ciliary sulcus was the common site of implantation for many years, pediatric ophthalmologists increasingly recognize that the ideal site for IOL implantation is in the bag. [7] Clinically, we have encountered serious challenges attempting secondary IOL implantation via conventional techniques in pediatric aphakic eyes, which are commonly characterized by severely fibrotic, fused anterior-posterior-capsulotomy edges and a doughnut-like Soemmering ring after many years without follow-up. In some cases, this ring of intracapsular lens material can become quite bulky, leaving less space in the ciliary sulcus for IOL placement and causing inevitable iris chafing and secondary glaucoma. Under these circumstances, when the IOL was placed into the bag, the anterior capsule was likely to tear
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