Intraocular Lens Implantation In Infants Research Articles

Ten-year refractive and visual outcomes of intraocular lens implantation in infants with congenital cataract.

There is no consensus regarding optimal target refraction after intraocular lens implantation in infants. This study aimed to clarify relationships of initial postoperative refraction with long-term refractive and visual outcomes. This retrospective review included 14 infants (22 eyes) who underwent unilateral or bilateral cataract extraction and primary intraocular lens implantation before the age of 1 year. All infants had ≥10 years of follow-up. All eyes exhibited myopic shift over a mean follow-up period of 15.9 ± 2.8 years. The greatest myopic shift occurred in the first postoperative year (mean=-5.39 ± +3.50 dioptres [D]), but smaller amounts continued beyond the tenth year (mean=-2.64 ± +2.02 D between 10 years postoperatively and last follow-up). Total myopic shift at 10 years ranged from -21.88 to -3.75 D (mean=-11.62 ± +5.14 D). Younger age at operation was correlated with larger myopic shifts at 1 year (P=0.025) and 10 years (P=0.006) postoperatively. Immediate postoperative refraction was a predictor of spherical equivalent refraction at 1 year (P=0.015) but not at 10 years (P=0.116). Immediate postoperative refraction was negatively correlated with final best-corrected visual acuity (BCVA) (P=0.018). Immediate postoperative refraction of ≥+7.00 D was correlated with worse final BCVA (P=0.029). Considerable variation in myopic shift hinders the prediction of long-term refractive outcomes in individual patients. When selecting target refraction in infants, low to moderate hyperopia (<+7.00 D) should be considered to balance the avoidance of high myopia in adulthood with the risk of worse long-term visual acuity related to high postoperative hyperopia.

Primary intraocular lens implantation in infants with unilateral congenital cataract operated before 12 weeks of age

The aim of this study was to report visual outcome and safety after cataract surgery with primary intraocular lens implantation before 12 weeks of age. Infants with visually significant unilateral congenital cataract having primary IOL implantation in the capsular bag before 12 weeks of age in 2007-2016 were enrolled for a prospective study examination in 2017. The medical records were also reviewed. In total, 23 patients with a median age at cataract surgery of 32 days (range, 12-75 days) were included. Seventeen (74%) eyes had persistent foetal vasculature (PFV). After a median follow-up of 6.3 years (range, 1.4-10.9 years), the corrected distance visual acuity was 0.8 logMAR (range, 3.0-0.1 logMAR). All, except one eye, required surgery for visual axis opacification (VAO), with a median of two (range 0-5) additional surgical procedures. Four (17%) eyes developed secondary glaucoma. Cataract surgery with primary IOL implantation before 12 weeks of age resulted in a high number of VAO operations, and the visual outcome varied considerably, showing the range in outcome for this challenging patient group. Co-existent PFV in these young patients was common. The incidence of secondary glaucoma was similar to other studies, despite the young age at surgery, high percentage of PFV and number of surgical procedures for VAO.

Intraocular Lenses for Infants With Aphakia

&#x0D; This systematic review examined intraocular lens implantation in patients aged 12 months or younger at the time of surgery compared with patients aged 12 months or younger with aphakia treated with contact lenses or glasses. It also examined intraocular lens implantation in patients aged 12 months or younger at the time of surgery (i.e., infants) compared with patients older than 12 months up to 12 years of age at the time of surgery (i.e., children).&#x0D; In total, 18 studies (3 randomized controlled trials and 15 nonrandomized studies) were identified that answered the clinical questions relevant to this review. No relevant studies were identified to inform the cost-effectiveness questions.&#x0D; Visual outcomes (i.e., visual acuity) did not seem to differ between patients aged 12 months or younger at the time of surgery who received intraocular lens implantation and in patients with aphakia treated with contact lenses or glasses. Parenting stress was higher in parents of infants who received intraocular lens implantation at 3 months after surgery compared with parents of infants who were treated with contact lenses; however, this difference was not maintained at 1 year after surgery.&#x0D; In 1 study that examined intraocular lens implantation at different ages, age did not appear to be a significant prognostic factor in poor visual outcomes (i.e., visual acuity defined as &gt; 0.5 logMAR).&#x0D; Regarding safety, infants who underwent intraocular lens implantation experienced more frequent occurrences of complications, such as visual axis opacification, compared with infants with aphakia treated with contact lenses or glasses; therefore, more reoperations to remove the opacification were required. Many infants with aphakia who did not receive intraocular lens implantation eventually required the surgery when they got older.&#x0D; There were limited statistical comparisons available for safety outcomes for intraocular lens implantation in infants at different ages. Overall, the incidence in adverse events was similar between infants and children, except for the number of additional surgeries. In the identified literature, younger patients received more additional surgeries than older patients.&#x0D; The risk of bias in the included studies was high. There were many methodological concerns, including selection bias, reporting issues, statistical issues, and study designs with high risk of bias, such as retrospective cohort studies.&#x0D; Family input regarding patients’ and caregivers’ experiences included reports of stress related to the use of contact lenses and stress about outcomes of the cataract removal and/or intraocular lens implantation and the effect on the child, and emphasized timely treatment to ensure optimal development of the child.&#x0D;

Effect of Age at Primary Intraocular Lens Implantation on Refractive Growth in Young Children.

To evaluate the effect of age at primary intraocular lens (IOL) implantation on rate of refractive growth (RRG3) during childhood. A retrospective chart review was performed for children undergoing primary IOL implantation during cataract surgery. RRG3 was calculated for one eye from each patient using the first postoperative refraction, last refraction that remained stable (< 1.00 diopters [D] change/2 years), and the corresponding ages. RRG3 values for pseudophakic patients operated on from ages 0 to 5 months were compared with values for patients operated on at ages 6 to 23 months and 24 to 72 months. Patients with refractive errors that stabilized were grouped by age at surgery to compare age at refractive plateau. Of 296 eyes identified from 219 patients, 46 eyes met the inclusion criteria. There was a statistically significant difference in RRG3 among age groups. The mean RRG3 value was -19.82 ± 5.23 D for the 0 to 5 months group, -22.32 ± 7.45 D for the 6 to 23 months group (0 to 5 months vs 6 to 23 months, P = .43), and -9.64 ± 11.95 D for the 24 to 72 months group (0 to 5 months vs 24 to 72 months, P = .01). Age at primary IOL implantation affects the RRG3, especially for children 0 to 23 months old at surgery. Surgeons performing primary IOL implantation in infants may want to use age-adjusted assumptions, because faster refractive growth rates can be expected in young children. [J Pediatr Ophthalmol Strabismus. 2020;57(4):264-270.].

Long-term outcomes following primary intraocular lens implantation in infants younger than 6 months

Purpose:To study the long-term safety profile and visual outcomes of primary intraocular lens (IOL) implantation in infants <6 months of age.Methods:This was a retrospective observational study conducted at a tertiary eye care center in South India. Infants under 6 months meeting the selection criteria who underwent cataract surgery (lens aspiration, primary posterior capsulorhexis, and anterior vitrectomy) with primary IOL implantation between January 2008 and December 2011 and minimum 3-year follow-up were included. Patient demographics, serial refractions, visual acuity, complications, and associated amblyopia/strabismus were reviewed. Visual acuity, myopic shift, and complications were the outcome measures.Results:Sixty-nine eyes of 38 infants (31 bilateral; mean age: 4.6 months) were reviewed. Mean follow-up was 51 months (range: 36–84). Median logMAR best-corrected visual acuity at the final visit was 0.74 (interquartile range [IQR]: 0.50–0.98) in eyes with bilateral cataracts and 0.87 (IQR: 0.60–1.14) in eyes with unilateral cataracts with an average myopic shift of 6.7 diopters over 4.2 years. Most common postoperative complication was visual axis opacification (VAO) (13 eyes, 18%), necessitating membranectomy followed by pigmentary IOL deposits (11 eyes, 15%), and IOL decentration and glaucoma in four eyes each (5.6%). Mixed linear effect model found no significant association of age, gender, laterality, and postoperative complications with final visual acuity (P ≥ 0.05). Eyes with unilateral cataracts had a greater myopic shift than bilateral cases (P = 0.03).Conclusion:Primary IOL implantation in infants <6 months is reasonably safe in appropriately selected infants. VAO was the most common postoperative complication, and a large myopic shift was observed.

Long-term results of primary intraocular lens implantation in infants: Our experience

Objective: The main objective of this study is to analyze the long-term outcome in children who underwent cataract surgery for congenital cataract with intraocular lens (IOL) implantation

Primary intraocular lens implantation in infants less than 6 months: a long term outcome

Intraocular lens (IOL) implantation in infants still remains challenging despite advances in pediatric cataract surgery. We aimed to study the long-term safety profile and visual outcomes of primary IOL implantation in infants less than 6 months of age.

Visual outcomes and complications of cataract surgery with primary implantation in infants

To describe the visual results and postoperative complications of cataract surgery with primary intraocular lens (IOL) implantation performed in infants and to determine possible predictive factors related to poor visual outcome. A retrospective consecutive case series of cataract surgeries with primary IOL implantation in infants was performed. Visual outcome and postoperative complications were recorded. A final visual acuity>0.5 logMAR was considered as a poor visual outcome. Sixty-one consecutive procedures were evaluated in 43infants. Eighteen infants (42%) had bilateral cataract surgery and 25(58%) had monocular surgery. The median age at primary surgery was 5.7months (range: 4weeks-24months). The median follow-up was 47months (range: 14-60months). The median best-corrected visual acuity in logarithm of the minimum angle of resolution (logMAR) at the last follow-up examination was 1.00 in the case of unilateral surgery and 0.40 in the case of bilateral surgery. The overall visual result in all eyes was 0.50logMAR. A better visual result was achieved when the infants were younger than 6months or older than 12months of age when surgery was performed. Opacification in the visual axis requiring secondary surgery occurred in 54% of the eyes (33/61). Postoperative inflammation occurred in 41% of the eyes (25/61) but was not associated with poor visual outcome (P=0.39). Glaucoma affected 11.5% of the eyes (7/61) and was significantly associated with poorer visual function (OR: 15.36, 95% CI 1.02-230.35, P=0.05). Compared with the unilateral cataract group, the OR of poor visual acuity was 0.06 (95% CI 0.01-0.35, P<0.01) in the bilateral cataract group. No statistical association was observed between final visual acuity>0.5 logMAR and leukocoria at time of diagnosis, IOL-related complications and postoperative strabismus. Primary IOL implantation is associated with an overall satisfactory visual outcome, especially when surgery is performed before 6months or after 12months of age and in bilateral cases. Glaucoma is the main complication associated with poor visual outcome.

Refractive error and anisometropia after unilateral intraocular lens implantation in infants under 7 months of age—results at 5 years of age from the Infant Aphakia Treatment Study (IATS)

Refractive error and anisometropia after unilateral intraocular lens implantation in infants under 7 months of age—results at 5 years of age from the Infant Aphakia Treatment Study (IATS)

Outcome of primary intraocular lens implantation in infants: Complications and rates of additional surgery

To study the requirement of additional surgery and adverse events in infants having primary intraocular lens (IOL) implantation. Tertiary care institute, Chandigarh, India. Prospective observational noncomparative case series. Infants who had phacoaspiration, primary posterior capsulotomy, anterior vitrectomy, and primary IOL implantation were evaluated for complications and the need for additional surgery over a 3-year period. The main outcome measures were the rate of complications, adverse events, and need for additional surgery. Sixty infants (100 eyes) with a mean age of 7.13months±2.32 (SD) (range 3 to 12months) were studied. The mean follow-up was 41.2±3.5months. Indication of additional surgery included visual axis opacification in 13 eyes, pupillary membrane/IOL decentration in 4eyes, and iris prolapse in 4 eyes. Adverse events included pigment on the IOL in 14 eyes and iridolenticular adhesions in 9 eyes. Ocular hypertension was observed in 2 eyes. The IOL was placed in sulcus or by optic capture in 14 eyes. There was no difference in additional surgery and adverse events between infants aged 6months or younger versus those older than 6months (P=.734). There was a low incidence of adverse events and additional surgery requirement in infants who had cataract surgery with primary IOL implantation. None of the authors has a financial or proprietary interest in any material or method mentioned.

Complications in the First 5 Years Following Cataract Surgery in Infants With and Without Intraocular Lens Implantation in the Infant Aphakia Treatment Study

To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation. Prospective randomized clinical trial. A total of 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character, and severity of intraoperative complications, adverse events, and additional intraocular surgeries during the first 5 postoperative years in the 2 groups were examined. There were more patients with intraoperative complications (28% vs 11%, P = .031), adverse events (81% vs 56%, P = .008), and more additional intraocular surgeries (72% vs 16%, P < .0001) in the IOL group than in the contact lens group. However, the number of patients with adverse events in the contact lens group increased (15 to 24) in postoperative years 2-5 compared to the first postoperative year, while it decreased (44 to 14) in years 2-5 compared to the first postoperative year in the IOL group. If only one half of the patients in the contact lens (aphakic) group eventually undergo secondary IOL implantation, the number of additional intraocular surgeries in the 2 groups will be approximately equal. The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants <7 months of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction.

Results of congenital cataract surgery with and without intraocular lens implantation in infants and children

Operations for congenital cataract in children in the past had resulted in aphakia. Improvement in surgical tools and techniques as well as in intraocular lens (IOL) implantation has led to correction of the aphakia by IOL implantation. We report the outcome of cataract surgery with and without IOL on these children in our institution between 1991-2008. In this retrospective cohort study, the medical records of all children who underwent surgery for congenital cataract were reviewed. The final study group included 144 children (218 eyes). Postoperative visual acuity (VA) was tested either by Teller Acuity Cards (in preverbal children) or by the Snellen chart. Data on VA status and postoperative complications were retrieved. Patients with bilateral cataract had better postoperative VA than patients with unilateral cataract (logMAR 0.559 ± 0.455 vs. 0.919 ± 0.685, respectively, P < 0.001). Children who underwent IOL implantation had better postoperative VA than those who did not, but the type of surgery had no significant effect after correction for the child's age at surgery (P = 0.346). Secondary cataract occurred more frequently in the extra-capsular cataract extraction (ECCE) + IOL implantation group than in the ECCE only group (20.6 % vs. 8.3 %, respectively, P = 0.018). Patients with bilateral cataract had better postoperative VA compared with those with unilateral cataract. The type of surgery had no effect on final VA, but there was a higher rate of secondary cataract in the ECCE + IOL patients compared to the ECCE only patients.

Educational paper

Congenital cataract is the commonest worldwide cause of lifelong visual loss in children. Although congenital cataracts have a diverse aetiology, in many children, a cause is not identified; however, autosomal dominant inheritance is commonly seen. Early diagnosis either on the post-natal ward or in the community is important because appropriate intervention can result in good levels of visual function. However, visual outcome is largely dependent on the timing of surgery when dense cataracts are present. Good outcomes have been reported in children undergoing surgery before 6 weeks of age in children with unilateral cataract and before 10 weeks of age in bilateral cases. Placement of an artificial intraocular lens implant after removal of the cataract has become established practice in children over 2 years of age. There remains debate over the safety and predictability of intraocular lens implantation in infants. Despite early surgery and aggressive optical rehabilitation, children may still develop deprivation amblyopia, nystagmus, strabismus, and glaucoma. The diagnosis and management of congenital cataracts has improved substantially over the past 30 years with a concurrent improvement in outcomes for affected children. Many aspects of the pre-, intra-, and postoperative management of these patients continue to be refined, highlighting the need for good quality data and prospective collaborative studies in this field.

Visual results and complications of primary intraocular lens implantation in infants aged 6 to 12 months

To present the visual results and the complications of primary intraocular lens (IOL) implantation in infants aged 6 to 12 months between January 2002 and July 2007. A total of 26 consecutive eyes, of 16 infants with cataract aged 6 to 12 months, were reviewed in the study. All patients had cataract extraction with anterior and posterior capsulorrhexis combined with anterior vitrectomy and primary hydrophobic acrylic IOL implantation. Six infants (six eyes) had unilateral congenital cataract and ten (20 eyes), bilateral cataract. Visual acuity and complications were recorded throughout the 46.4-month mean follow-up (range 22 to 79 months). All eyes had primary IOL implantation. The mean best-corrected visual acuity (logMAR) was 0.98 +/- 0.18,0.50 +/- 0.14 and 0.61 +/- 0.25 for unilateral, bilateral and all eyes respectively at the last follow-up. IOLs were implanted in the capsular bag of 25 eyes (96.2%) and in the sulcus of the remaining one eye (3.8%). Seven eyes (26.9%) developed visual axis opacification (VAO), and four eyes required secondary pars plana vitrectomy (PPV). IOL opacification occurred in one eye 54 months after implantation. Late onset open-angle glaucoma developed in one eye, and required trabeculectomy surgery. The predictors of good best-corrected visual acuity (BCVA) included partial cataract, bilateral cataract, absence of strabismus or nystagmus, and good amblyopic treatment. The greatest annual myopic change (5.15 +/- 2.08 D) was observed during the first 12 months after surgery. In unilateral cases, there was no significant difference in the axial length between the cataractous eye and the fellow normal eye both at the time of surgery (P = 0.891) and final follow-up (P = 0.693). Primary IOL implantation was safe and effective for infantile cataract surgery. Total or unilateral cataract, nystagmus or strabismus, and inadequate amblyopic therapy were predictors of poor BCVA. Significant myopic shifts occurred especially in infants in the first year of surgery. The pseudophakic eye had a similar growth rate, as measured by axial length, to that of the fellow normal eye, in unilateral cases.

Refractive outcomes in primary intraocular lens implantation in infants

Introduction: To evaluate the accuracy of lens calculation and the refractive outcome following primary IOL implantation in patients less than 12 months old. Method: A retrospective case review of 25 patients (33 eyes). Variables included were as follows: age at surgery, axial length, target refraction, and presence of systemic and ocular pathologies. Outcome measures were refractive error at 4 weeks, lens calculation error (difference between target and 4-week refraction) and refractive error at 18 months of age. Results/Discussion: Mean target refraction was 7.23 ± 2.67 DS (range, 1.86-13.20) and mean refraction at 4 weeks was 7.07 ± 3.23 DS (range, 0.75-14.00), with 82% of cases within ±2 DS from target. Lens calculation error ranged from +2.75 to −4.51 DS, with a mean value of −0.167 ± 1.63 DS. Logistic regression analysis demonstrated how neither age, axial length, target refraction, nor presence of systemic pathologies could predict a 4-week refraction within ±2 DS from target (p = 0.438). Multiple regression analysis showed that lens calculation error (p = 0.001) and axial length (p = 0.008) are correlated with refractive error at 18 months age. Patients with trisomy 21 are significantly more myopic (−0.43 ± 3.88 DS) than controls (3.10 ± 3.60 DS; p = 0.035) at 18 months. Conclusions: IOL power in infants can be calculated with reasonable accuracy using current formulae. There are no valid predictors that can anticipate lens calculation error within ±2 DS. Patients with trisomy 21 have a significantly more myopic outcome at 18 months of age than other patients.

Primary intraocular lens implantation in infants: Complications and visual results

To evaluate the complications and visual results in a consecutive series of patients having cataract extraction with intraocular lens (IOL) implantation in the first year of life. St. Erik's Eye Hospital, Stockholm, Sweden. This retrospective study comprised 28 children (31 eyes) who had cataract surgery with primary IOL implantation. The median age at surgery was 2.5 months (range 8 days to 10 months). The median follow-up was 36 months. Two newborns with persistent fetal vasculature (PFV) who had surgery at 8 days and 17 days, respectively, developed intraoperative vitreous hemorrhage; a retinal detachment developed in 1 of the eyes. Intraocular lens luxation occurred in 2 infants with PFV. Seventy percent of eyes developed opacification of the visual axis that required additional surgery. Chronic glaucoma developed in 2 eyes and transitory glaucoma in 1 eye. Two of the glaucoma cases occurred in eyes with PFV. In 7 eyes of 4 infants with bilateral cataract, the median visual acuity was 20/63 (range 20/25 to 20/100). In 12 infants with unilateral cataract without PFV, 7 achieved a visual acuity between 20/32 and 20/200 (median 20/63), 4 achieved counting fingers (CF), and 1 achieved light perception. In 12 eyes with PFV, 2 achieved a visual acuity of 20/200 and the rest achieved CF or worse. After-cataract with membrane formation was the main complication in infants with primary IOL implantation. The glaucoma incidence was low at the last follow-up.

Changes in refraction and ocular dimensions after cataract surgery and primary intraocular lens implantation in infants

To study refraction and axial length changes after cataract extraction and primary intraocular lens (IOL) implantation in children younger than 1 year of age. Two regional hospitals. After determining the IOL power for emmetropia, 80% of the value was used to choose the IOL for implantation to counter anticipated myopic shift with age. The main outcome measures were changes in refraction and axial length 3 years after surgery. Thirty-four eyes of 20 children (mean age 6.7 months +/- 3.9 [SD]) were studied. Refraction in the immediate postoperative period was +4.53 +/- 1.45 diopters (D). Three years after surgery, the mean refraction was -2.49 +/- 3.08 D (P<.001). Twenty-two eyes (64.7%) had surgery during the first 6 months of life (group 1) and had a shorter axial length at surgery (mean 18.92 +/- 1.32 mm) compared with 12 eyes (35.3%) that received surgery between 7 and 12 months (group 2, mean 20.29 +/- 1.00 mm) (P = .007). However, the final axial length was greater in group 1 (mean 22.67 +/- 1.04 mm) than in group 2 (mean 21.23 +/- 0.26 mm) (P = .019). Primary IOL implantation is an option for children having cataract surgery in the first year of life. Significant myopic shifts occurred, and this seemed to be more pronounced in younger children. It appears that rethinking current strategies for IOL power calculation may be required to achieve more optimal refractive outcomes.

Cataract Extraction and Primary Hydrophobic Acrylic Intraocular Lens Implantation in Infants

We sought to report the incidence of visual axis opacification and to evaluate the complication and reoperation rates after intraocular lens implantation in infants. Twenty-one infants (31 eyes) who had cataract extraction with primary hydrophobic acrylic IOL implantation between October 1996 and May 2002 were reviewed. Posterior capsule was left intact in 14 eyes (group A); posterior capsulorrhexis or capsulotomy with anterior vitrectomy was performed in 17 eyes (group B). Complication and reoperation rates were compared with an age-matched control group of 17 patients (33 eyes) who were left aphakic after pars plicata lensectomy. Mean follow-up period was 41 months (range, 22-75 months) in group A, 37 months (range, 10-75 months) in group B, and 52 months (range, 7-97 months) in the control group. Mean age of the patients was 6.8 months (range, 3-10 months) in group A, 8.9 months (range, 3-18 months) in group B, and 4.9 months (range, 1-15 months) in the control group. Visual axis opacification was significantly higher in group A (86%) when compared with group B (17.6%; P < 0.0001). No significant difference was found in terms of pupillary irregularities and peripheral anterior synechiae formation between pseudophakic and aphakic group ( P = 0.43 and P = 0.306, respectively), whereas pigment dispersion and fibrinous reaction were significantly more common in the pseudophakic group ( P = 0.002). Serious complications, such as retinal detachment, pseudophakic bullous keratopathy, and secondary glaucoma, did not develop in any eye. Reoperation rate was significantly higher in group A (78%) when compared with group B (17%) and the control group (12%; P = 0.0011 and P < 0.0001, respectively). Visual axis opacification requiring a reoperation was significantly more common in patients with an intact posterior capsule. To decrease the reoperation rate and maintain a clear visual axis, posterior capsulorrhexis with anterior vitrectomy should be performed. Even although early complications were quite frequent, serious late complications were not encountered in any eye. Therefore, under appropriate conditions, IOL implantation is a suitable alternative in infants.

Preliminary results of intraocular lens implantation in infants with cataract under two years old

To explore the feasibility of anterior and posterior capsulorhexis combined with anterior vitrectomy and intraocular lens implantation in infants with cataract under 2 years old. Anterior and posterior capsulorhexis combined with anterior vitrectomy and intraocular lens implantation was performed in 22 cases (27 eyes) of infants with cataract under 2 years old. The results during and after the operation were observed. The mean follow-up time was 12 months. All surgeries were performed smoothly. The visual axis remained clear in 26 eyes (96%) after operation, there was white fibrosis and opacification posterior to the intraocular lens in 1 eye and needed re-operation, up drawn pupil in 3 eyes (11%), pupillary capture in 2 eyes (7%) and posterior synechia of the iris in 4 eyes (15%). Anterior and posterior capsulorhexis combined with anterior vitrectomy and intraocular lens implantation in infants with cataract under 2 years old can keep visual axis clear and restore the normal anatomy of anterior segment of the eye, the complications are reduced greatly. However, the ultimate visual acuity needs further observation.

Management of pediatric cataract and lens opacities.

The diagnosis and surgical management of cataracts in children has benefitted from improvements in microsurgical techniques. Intraocular lens placement has become standard in children 2 years of age and older. Initial experience with intraocular lens implantation in infants found a high rate of surgical complications. However, refinements in surgical techniques may lesson these complications. Posterior capsule opacification is a frequent postoperative problem after pediatric cataract surgery. Posterior continuous curvilinear capsulorhexis with anterior vitrectomy is an effective means to prevent opacification of the visual axis in children.