Intraocular lens implantation in unilateral congenital cataract with minimal levels of persistent fetal vasculature in the first 18months of life.

Toshihiko Matsuo

doi:10.1186/2193-1801-3-361

Abstract

PurposeTo describe the incidence of unilateral congenital cataract associated with minimal (ultrasonically undetectable) levels of persistent fetal vasculature in the first 18 months of the life and to report surgical methods for intraocular lens implantation, using 25-gauge vitrectomy system.MethodsRetrospective review was made on 16 consecutive patients with bilateral or unilateral congenital cataract in the first 18 months of the life who underwent surgery at Okayama University Hospital after the introduction of the 25-gauge vitrectomy system from October 2005 to March 2013. As the standard of care at this hospital in the study period, intraocular lenses were not implanted in children with bilateral cataract while intraocular lenses were implanted in those with unilateral cataract.ResultsTen children with bilateral cataract underwent lensectomy in both eyes with a 25-gauge vitreous cutter under irrigation with a 25-gauge infusion cannula, inserted from two side ports at the corneal limbus. Six children with unilateral cataract underwent intraocular lens implantation and posterior capsulotomy after lens aspiration from limbal side ports. No patient showed vitreous abnormalities on ultrasound examinations before the surgery. At the surgery, all 10 children with bilateral cataract showed no additional abnormalities. In contrast, 3 children with unilateral cataract at the age younger than 12 months showed white fibrous tissue in the anterior vitreous integrated with the posterior lens capsule while the other 3 children with unilateral cataract at the age from 12 to 18 months did not have vitreous abnormalities. The fibrous tissue was cut together in the process of posterior capsulotomy from a 25-gauge trocar inserted at 1.5 mm posterior from the corneal limbus.ConclusionsUnilateral congenital cataract in the first 12 months of the life has a high incidence for the association with anterior type of persistent fetal vasculature which could not be detected by preoperative ultrasound examinations. Intraocular lens implantation was technically feasible in unilateral cataract with or without minimal levels of persistent fetal vasculature in the first 18 months of the life.

Highlights

The fibrous tissue was cut together in the process of posterior capsulotomy from a 25-gauge trocar inserted at the pars plicata, 1.5 mm posterior from the corneal limbus (Figure 1)
In case of implanting the intraocular lens, cataract surgery was done as usual as in adults, and posterior capsulotomy with anterior vitrectomy was performed through the pars plana or plicata (O’Keefe et al 2001; Swamy et al 2007)
We described, for the first time, a systematic surgical method for congenital cataract, using 25-gauge vitrectomy system

Summary

Introduction

Unilateral cataracts are sporadic and sometimes associated with other anomalies such as persistent hyperplastic primary vitreous (Morrison et al 2011; Mullner-Eidenbock et al 2004; Vasavada et al 2012). The persistent hyperplastic primary vitreous (PHPV) is the presence of fetal hyaloid vascular system or its remnant in the vitreous cavity at birth (Dass and Trese 1999; Goldberg 1997; Haddad et al 1978; Hunt et al 2005; Peyman et al 1976; Pollard 1997; Reese 1955). The situation is called persistent fetal vasculature (Goldberg 1997), which has been coined as a new term and advocated to be used in place of PHPV. The persistent fetal vasculature or PHPV is classified largely into two types, posterior type and anterior type, based on the clinical pictures

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