Posterior Optic Capture Research Articles

IOL calculation using six formulas in children undergoing lens extraction and primary IOL implantation with and without posterior optic capture.

To evaluate formulas for intraocular lens (IOL) calculation in children undergoing lens extraction and IOL implantation. Retrospective, consecutive case series at the Department of Ophthalmology, Goethe University Frankfurt, Germany. We included eyes that received lens extraction and IOL implantation (SN60AT, Alcon, Fort Worth, TX) due to congenital or juvenile cataract. Preoperative assessments included biometry (IOLMaster 500/700, Carl Zeiss Meditec, Germany). To evaluate the measurements, we compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of six different formulas, and number of eyes within ± 0.5, ± 1.0, ± 2.0D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4-12 weeks after surgery. 66 eyes matched our inclusion criteria with a mean age of 6.3 years ± 3.2. MedAE was lowest in SRK/T (0.55D ± 1.08) followed by Holladay I (0.75D ± 1.00), EVO 2.0 (0.80D ± 0.89), Barrett Universal II (BUII, 0.86D ± 1.00), Hoffer Q (0.97 D ± 0.94), and Haigis (1.10D ± 0.95). Regarding eyes within ± 0.5D SRK/T (45.5.%, 30 eyes) performed best, followed by Holladay I (36.4%, 24 eyes), EVO 2.0 and BUII (each 34.8%, 23 eyes). There was a myopic shift seen in all formulas (MPE: -0.21 to -0.90D). Using modern formulas, or even AI formulas, for IOL calculation in children's eyes does barely improve predictability of the postoperative refraction. A myopic shift can be found for all formulas. However, specific formulas like SRK/T seem to better anticipate this.

Первичный задний капсулорексис: исторические аспекты и современное состояние вопроса

Abstract Primary posterior capsulorexis: historical aspects and the current state of the issue E.V. Egorova, A.O. Direev, S. Fyodorov Eye Microsurgery Federal State Institution, Novosibirsk Branch, Novosibirsk, Russian Federation Research Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation Purpose. The paper analyzes the data of modern literature (published from 2008 to 2023) on the history and technique of primary posterior capsulorexis (PPC). The fields of application, variations, effectiveness and safety of the procedure are considered. Material and methods. A search for research on the subject of work from 2008 to 2023 was carried out. The search was carried out using Google Academy electronic databases (https://scholar.google.ru/), PubMed (https://www.ncbi.nlm. nih.gov/pubmed/), eLIBRARY.ru (https://www.elibrary.ru/) and foreign and domestic journals devoted to ophthalmology. Results. An analysis of the literature has shown that performing PPC provides high visual results both in comparison with standard cataract surgery and in the case of primary fibrosis of the posterior capsule. The key points of the PPC method are: intact anterior hyaloid membrane, continuous tear-resistant edge of capsulorexis and its size, which allows the preserved part of the PC to provide adequate support for the IOL and form a circular capsule barrier along the edge of its optical part. However, some studies have shown the possibility of partial or complete «closure» of the capsulorexis area by proliferating epithelial cells of the lens (ECL) in adult patients. In pediatric practice, it is well known that posterior hyaloid membrane (PHM) can act as a matrix for the migration of ECL, and the frequency of opacity of the optical axis after PPC reaches 60%. Therefore, in a number of clinics, the standard algorithm for cataract surgery in children includes not only PPC, but also anterior vitrectomy, although this complex approach is not always effective. As a solution to the problem of opacity of the optical axis after PPC, the technique of «capturing the optics» of the IOL was proposed, which permanently eliminates the opacity of the optical axis behind the IOL and significantly reduces fibrosis, especially in combination with polishing the anterior capsule. Conclusion. A large number of studies analyzing the clinical results of the PPC method, performed over several decades with various types of IOLs, leaves no doubt that performing posterior capsulorexis is a well-controlled method that significantly reduces the frequency of secondary cataracts, adding a «second line of defense» without reducing the barrier effect along the optical edge. Key words: anterior hyaloid membrane, Berger’s space, continuous curvilinear capsulorhexis, posterior optic capture

Intraocular lens calculation using the ESCRS online calculator in pediatric eyes undergoing lens extraction.

To evaluate the ESCRS online calculator for intraocular lens (IOL) calculation in children undergoing lens extraction and primary IOL implantation. Department of Ophthalmology, Goethe-University Frankfurt, Frankfurt am Main, Germany. Retrospective, consecutive case series. Eyes that received phacoemulsification and IOL implantation (Acrysof SN60AT) due to congenital or juvenile cataract were included. We compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of formulas provided by the recently introduced online calculator provided by the ESCRS with the SRK/T formula, as well as the number of eyes within ±0.5 diopters (D), ±1.0 D, ±2.0 D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4 to 12 weeks postoperatively. 60 eyes from 47 patients with a mean age of 6.5 ± 3.2 years met the inclusion criteria. Mean axial length was 22.27 ± 1.19 mm. Mean preoperative spherical equivalent (SE) was -0.25 ± 3.78 D, and mean postoperative SE was 0.69 ± 1.53 D. The MedAE was lowest in the SRK/T formula (0.56 D, ± 1.03) performed significantly better ( P = .037) than Hoffer QST and Kane, followed by BUII (0.64 D, ± 0.92), Pearl DGS (0.65 D, ± 0.94), EVO (0.69 D, ± 0.94), Hoffer QST (0.75 D, ± 0.99), and Kane (0.78 D, ± 0.99). All of those were significantly above zero ( P < .001). 41 eyes received an intraoperative optic capture (68%). When excluding eyes that did not receive intraoperative optic capture (n = 19; 32%), the MedAE was shown to be lower. Using modern IOL calculation formulas provided by the ESCRS calculator provides good refractive predictability and compares for most of the formulas with the results with SRK/T. In addition, the formulas seem to anticipate the postoperative refraction better for eyes that receive a posterior optic capture.

Multifocal intraocular lens implantation in children with unilateral congenital cataracts.

To evaluate the vision recovery, reconstruction of binocular visual function, and influencing factors after multifocal intraocular lens implantation in children with unilateral congenital cataracts. University hospital. Prospective clinical study. In the prospective clinical study, 55 children aged 3 to 14 with unilateral congenital cataracts received multifocal intraocular lenses (TECNIS ZMB00) posterior optic capture from 2019 to 2022. Corrected distance visual acuity (CDVA; 5 m), distance-corrected intermediate visual acuity (DCIVA; 66 cm), distance-corrected near visual acuity (DCNVA; 33 cm), stereoscopic vision, visual quality (objective scatter index [OSI] and modulation transfer function [MTF]), axial length (AL), keratometry (K), and contrast sensitivity (CS), as well as postoperative occlusion compliance were evaluated before and after surgery. At the final follow-up, 90.91% (50/55) patients showed significant improvement in visual acuity (VA) after surgery. CDVA, DCIVA and DCNVA were 0.23 ± 0.17, 0.39 ± 0.15, and 0.44 ± 0.15 logMAR, respectively. 69.09% (38/55) patients achieved good VA (better than 0.3 logMAR).52.76% (25/48) patients had a positive Titmus test. OSI and MTF were 1.24 ± 0.91 and 42.45 ± 12.30, respectively. 73.68% (28/38) of the patients (better than 0.3 logMAR) underwent strict occlusion therapy. Postoperative VA is correlated with preoperative CDVA ( r = -0.829, P < .001), corneal astigmatism ( r = 0.384, P = .036), △AL (difference between the cataract eyes and contralateral eyes, r = -0.490, P = .006), and occlusion compliance ( r = -0.806, P < .001). Multifocal intraocular lens implantation could obtain relatively satisfactory VA (CDVA, DCIVA and DCNVA) and the binocular visual function of children with unilateral congenital cataracts. Postoperative VA is related to preoperative VA, corneal astigmatism, △AL, and occlusion compliance.

Рефракционные результаты хирургии катаракты с задним капсулорексисом и «захватом» оптики ИОЛ

Purpose. To compare refractive results in the following groups: after standard cataract surgery (1), standard cataract surgery supplemented with primary posterior capsulorhexis (2) and supplemented with a posterior capture of the IOL optics (3). Material and methods. This study included 32 patients (40 eyes) aged 52 to 68 years after uncomplicated phacoemulsification of age-related cataract with implantation of several models of monolithic flexible hydrophobic IOLs: Tecnis (J&amp;J), enVista (B&amp;L), RPR-2 (Reper-NN). The axial length of the eyes varied from 22.2 to 25,25 mm. The exclusion criteria were pseudoexfoliation syndrome and concomitant ophthalmopathology. Results. There were no intra- and postoperative complications in all studied groups. OCT monitoring showed the intactness of the anterior hyaloid in the second and third groups, the centered IOL position and the location of the capsular sheets according to the applied technology. The obtained refractive results were compared with the target refraction when calculating the IOL. The emmetropia was planned in all cases. However, because the strength of the lenses has discrete values with a step of 0.5 diopters, the closest value with a shift towards myopia was chosen. No statistically significant differences were found in the first and second compared groups when evaluating the refractive Results. However, the postoperative parameters were statistically significantly different in the third group with posterior optic capture. In this group a hyperopic shift of about 0,5 diopters was always observed. Conclusion. Primary posterior capsulorhexis with posterior optics capture provides a stable centered IOL position. The axial displacement of the IOL and the hypermetropic shift of the refractive results should be considered when planning posterior optical capture. Key words: posterior capsulorhexis, posterior optic capture, optic buttonholing

Surgical interventions for bilateral congenital cataract in children aged two years and under.

Surgical interventions for bilateral congenital cataract in children aged two years and under.

Visual outcomes in pediatric traumatic cataract

To study epidemiology, biometry and visual outcomes (with or without posterior capsulorhexis) in cases of pediatric traumatic cataract. This was a prospective observational study conducted on 30 children of traumatic cataract belonging to an age group of less than 16 years. All patients were subjected to detailed history and ocular examination. Patients underwent cataract surgery with or without intraocular lens (IOL) implantation. Posterior capsulorhexis with posterior optic capture was done in all patients presenting with primary posterior capsular opacity. All patients were followed up till 6 months and surgical outcomes in terms of Best Corrected Visual Acuity (BCVA), and visual axis opacification (VAO) were observed. Firecracker injury was found to be the most common causal agent, followed by arrow and ball injuries. Males were more commonly injured than females (70%:30%). Open-globe injury was more frequent than closed globe injury (CGI) (53.3%:46.7%). Anterior capsular rupture was the most frequent preoperative complication. Mean axial length was 22.53 which was not significantly different from the fellow eye. 3 patients were left aphakic, 10 patients underwent single piece IOL implantation and 16 patients underwent multipiece IOL implantation. Anterior chamber IOL (ACIOL) was implanted in one case. Intraoperatively 6 patients were found to have posterior capsular plaque and were implanted with multipiece IOL with posterior optic capture. Visual acuity significantly improved in 21 out of 30 eyes from baseline after cataract surgery (p&amp;#60;0.001). 9 patients (30%) had posterior capsular opacification (PCO) on follow up. Posterior capsular opacity in pediatric traumatic cataracts can be effectively managed with posterior capsulorhexis and posterior optic capture.

Primary Intracapsular Polypseudophakia With Posterior Capsulotomy Optic Capture in a Nanophthalmic Eye

PURPOSE: To describe a novel technique for primary intracapsular polypseudophakia performed on a pediatric patient with unilateral posterior polar cataract in a nanophthalmic eye. METHODS: Phacoemulsification combined with primary posterior capsulotomy, anterior vitrectomy, and primary intracapsular polypseudophakia was performed to attain full refractive correction, resulting in a piggyback one-piece intraocular lens (IOL) in the capsular bag with posterior optic capture of an underlying three-piece IOL. RESULTS: There were no intraoperative or postoperative complications. By 2 months postoperatively, uncorrected distance visual acuity of 20/50 was achieved (secondary to amblyopia) with plano manifest refraction. CONCLUSIONS: This case demonstrates a useful technique in nanophthalmic or hypermetropic eyes for which alternative methods of correcting residual postoperative refractive error may be suboptimal. [ Journal of Refractive Surgery Case Reports . 2022;2(1):e14–e17.]

Review of primary posterior capsulorhexis in cataract surgery.

This article reviews the history and technique of primary posterior capsulorhexis with emphasis on anterior hyaloid membrane preservation and combined posterior optic capture of intraocular lenses into Berger's space for the purpose of lens stability and secondary cataract elimination among other potential advantages. Applications, variations, efficacy, and safety of the procedure are reviewed.

Posterior optic capture of intraocular lens in difficult cases of pediatric cataract.

We describe the technique of posterior optic capture without anterior vitrectomy in two difficult cases of pediatric cataract. We demonstrate how a three-piece foldable intraocular lens can be maneuvered behind the posterior capsule after an improvised posterior capsulotomy. This technique provided excellent intraocular lens (IOL) stability with the absence of lens epithelial cell proliferation in infants with altered posterior capsule morphology.

Full-Diffractive Multifocal Intraocular Lens Posterior Optic Capture for Selected Pediatric Cataracts.

To evaluate the short-term outcomes of implantation of a full-diffractive multifocal intraocular lens (IOL) with optic capture for selected pediatric cataracts. In this prospective study, patients with pediatric cataract aged 3 to 14 years were selected to receive multifocal IOL (Tecnis ZMB00; Abbott Medical Optics) posterior optic capture. Visual acuity, stereopsis, visual quality, and complications were assessed. Forty-five patients (66 eyes) were recruited with a follow-up of 9.09 ± 5.93 months (range: 6 to 24 months). The cataract was bilateral in 21 patients and unilateral in 24 patients. At the last follow-up visit, the mean distance-corrected distance, intermediate, and near visual acuity was 0.28 ± 0.25, 0.43 ± 0.24, and 0.39 ± 0.27 logMAR, respectively. Among the patients with bilateral cataract, postoperative corrected distance visual acuity (CDVA) was 20/40 or better in 79% (33 of 42) of the eyes and 20/20 in 26% (11 of 42) of the eyes. Of the patients with unilateral cataract, 54% (13 of 24) achieved a CDVA of 20/40 or better but none obtained a CDVA of 20/20. All patients developed stereopsis postoperatively (P < .05). There was no significant difference in modulation transfer function cut-off and Strehl ratio between the eyes with a multifocal IOL and the healthy eyes of patients with unilateral cataract (P > .05). Objective Scatter Index values were significantly better in the healthy eyes (P < .05). No posterior capsule opacification, posterior synechiae, secondary glaucoma, pigmentary IOL deposits, or IOL decentration was observed during the follow-up period. Short-term follow-up results suggest full-diffractive multifocal IOL optic capture may benefit appropriately selected patients with pediatric cataract. [J Refract Surg. 2021:37(6):390-397.].

Comparison of posterior optic capture of intraocular lens without vitrectomy vs endocapsular implantation with anterior vitrectomy in congenital cataract surgery: A randomized prospective study.

Purpose:To compare surgical outcome of two procedures in pediatric cataract surgery.Methods:Prospective randomised interventional study. Consecutive patients with bilateral congenital cataract who were operated during January 2016 to October 2016 at a tertiary care referral institute were included. One eye of all patients underwent Intraocular lens (IOL) implantation with optic capture through a primary posterior continuous curvilinear capsulorhexis (PPC) without vitrectomy while in the other eye endocapsular IOL implantation was performed along with PPC and anterior vitrectomy. Intraoperative challenges and postoperative complications were noted.Results:15/18 children who fulfilled the inclusion criteria were included for follow up analysis. Mean age at the time of surgery was 21 ± 14.7 months. At a mean follow up of 25.69 ± 1.06 months; all eyes in both groups maintained a clinically centred IOL with clear visual axis. One patient with endocapsular IOL implantation developed anterior capsular phimosis. The rate of fibrinous complications (IOL deposits and synechiae) were more in the eyes with IOL in the bag (6 eyes) vs eyes where posterior optic capture was done (1 eye); P = 0.039.Conclusion:Posterior optic capture is a safer alternative to conventional pediatric cataract surgery in terms of inflammatory sequelae and lens epithelial cell proliferation. However the two methods work equally well in preventing visual axis obscuration over a long follow-up.

Comparing the outcome of intraocular lens implantation with or without posterior optic capture in pediatric cataract surgery

Purpose To evaluate the outcome of intraocular lens (IOL) implantation with posterior optic capture versus in-the-bag implantation in pediatric cataract surgery. Setting Ain Shams University Hospital and Research Institute of Ophthalmology. Design It is a prospective, comparative clinical study. Patients and methods Thirty eyes with developmental cataract underwent primary cataract extraction and IOL implantation of hydrophobic acrylic multipiece Sensar IOL AR40e. In all cases, anterior and posterior continuous curvilinear capsulorrhexis, lens aspiration, and anterior vitrectomy were performed. IOL was implanted in the ciliary sulcus, and the optic was captured in both anterior and posterior capsulorrhexis in group A (15 eyes) and implanted in the bag without capture in group B (15 eyes). Visual acuity, visual axis opacification, red reflex, intraocular pressure, centration, and complications were all assessed. Results The mean age of children was 5.3±2.93 years. At 6 months of follow-up, the mean postoperative corrected distant visual acuity was 0.69±0.19 and 0.65±0.23 in groups A and B, respectively. The mean clear central zone was 4.29±0.24 and 3.6±0.55 mm in groups A and B, respectively (P=0.001). The mean IOL decentration measured in mm was 1.61±1.17 and 0.86±0.28 SD in groups A and B, respectively (P=0.003). There were no postoperative complications in all cases. Conclusion Placement of IOL haptics in the ciliary sulcus while capturing the optic through the posterior continuous curvilinear capsulorrhexis provides more central clarity of the visual axis, however IOL decentration was more common.

Infantile cataract: comparison of two surgical approaches

ObjectiveTo compare the results of 2 cataract extraction techniques with primary intraocular lens (IOL) implantation in children. DesignRetrospective comparative case series study. MethodsThis study included children with congenital or developmental cataract. In all cases, anterior capsulorhexis, lens aspiration, posterior continuous curvilinear capsulorhexis, and primary IOL implantation were performed. We compared 2 surgical approaches. In the first approach, after IOL implantation in the bag, posterior optic capture (OC) was performed without anterior vitrectomy (OC technique); in the second approach, anterior vitrectomy was performed without OC of the IOL (AV technique). Patient demographic data as well as ethnic origin, child’s age at cataract diagnosis, child’s age at surgery, axial length, IOL power in diopters, visual acuity, visual axis opacification, and complications were assessed. ResultsOne hundred twenty-three eyes were included for surgical approach outcomes comparison; 21 eyes underwent the OC surgical approach and 102 the AV surgical approach. The mean patient age at surgery was 57.3 ± 47.1 months. The mean follow-up was 63.13 months (range 12–202 months). Epithelial lens reproliferation was the major adverse event in our series, affecting 21.1% of patients’ eyes; the mean time to epithelial lens reproliferation development was 90 ± 9.70 months. There was no statistically significant difference between the two groups in best spectacle-corrected visual acuity or epithelial lens reproliferation incidence. ConclusionsIn our case series we did not find any difference between surgical techniques.

Predictability of Intraocular Lens Calculation Using the Holladay II Formula after in-the-Bag or Optic Captured Posterior Chamber Intraocular Lens Implantation in Paediatric Cataracts

Purpose: To assess the predictability of postoperative refraction using the Holladay II-formula in paediatric patients randomized to undergo 2 different surgical procedures. Methods: Fourty cataractous eyes of 29 patients (age 2.31–11.75 years) were operated with in-the-bag intraocular lens implantation. Randomly, either an anterior vitrectomy (group A, 19 eyes) or posterior optic capture without vitrectomy (group B, 21 eyes) was performed. Randomization was done in 4 separate age groups, in accordance with 4 target refractions (0, 1, 2 and 3 dpt) to compensate for the anticipated myopic shift. Results: The predicted refraction correlated with the achieved postoperative refraction (total group, p = 0.019), closer in group A (p = 0.033) than in group B (p = 0.265); however, the results of groups A and B were not significantly different (p = 0.324). There was a tendency for postoperative targeted hyperopia being underachieved in the youngest patients. Conclusion: The Holladay II formula provides reliable intraocular lens calculation in paediatric cataracts. The tendency to underachieve the target refraction in younger patients needs further investigation.

Implantation of foldable intraocular lens with anterior optic capture in isolated posterior capsule rupture

We would like to raise several pertinent points regarding isolated posterior capsule rupture occurrence and its management described in the article by Pushker et al.1 Isolated posterior capsule rupture is a well-recognized clinical entity. In our literature review, we came across 22 cases reported prior to the authors' case.2–9 Previous authors suggest that the absence of a formed nucleus in young patients allows contrecoup forces to be transmitted through the lens substance.3 We theorize that its occurrence in young patients following blunt trauma is due to localized pressure buckling the cornea and deforming the soft nucleus (with posterior bulging against the posterior capsule). In addition, zonular tension pulls the posterior capsule centrifugally. This combination results in a blow-out rupture of the posterior capsule. We recently managed a similar case. Two months following blunt ocular trauma, a 19-year-old man had lens aspiration with implantation of an Alcon MA60BM intraocular lens (IOL) in the capsular bag. We aspirated the lens through a superior 2.75 mm clear corneal incision using automated irrigation/aspiration with an anterior chamber maintainer (ACM). With low-flow settings and the ACM, no vitreous prolapsed and anterior vitrectomy was not required. The posterior chamber IOL was placed in the capsular bag, with no optic capture, and has remained stable with over 1 year of follow-up. Even without grossly fibrotic edges, these posterior capsular defects are relatively stable and resistant to enlargement like posterior capsulorhexis. In essence, we feel that vitreous loss should be avoided with the attendant reduction in the risk for retinal detachments and cystoid macular edema. Plain capsular bag fixation is also possible in most cases and is ideal because prolapsing the optic anteriorly brings it closer to the iris and increases the risk for iris chafing and pigment dispersion. If the defect is extremely large or the edges of the posterior capsule defect are not visualized, the posterior chamber IOL haptics should be placed in the ciliary sulcus (with posterior optic capture through an intact anterior capsulorhexis). In fact, anterior optic capture was recommended by Gimbel and DeBroff10 in cases in which the posterior capsule tear occurred during or after posterior chamber IOL insertion rather than in cases with preexisting breaks. In cases of posterior capsule tear during or after posterior chamber IOL insertion, leaving the haptics in the capsular bag, rather than trying to dial them out into the sulcus, minimizes vitreous disturbance. Finally, we would like to point out that the Alcon MA30BA has polymethyl(methacrylate) haptics not polypropylene haptics as mentioned by the authors.

A retrospective comparison of techniques to prevent secondary cataract formation following posterior chamber intraocular lens implantation in infants and children: Koch DD, Kohnen T. Trans Am Ophthalmol Soc 1997;95:351–360

To determine the effect of various methods of managing the posterior capsule and anterior vitreous on the rate of posterior capsular opacification in children implanted with posterior chamber intraocular lenses (PC IOL).We reviewed the charts of 20 eyes of 15 children (1.5-12 years) who underwent primary cataract surgery with PC IOL in the last 5 years. The posterior capsule and anterior vitreous were managed in a variety of ways: in 5 eyes the posterior capsule was left intact, and 15 eyes underwent posterior continuous curvilinear capsulorhexis (PCCC)-nine cases without and 6 with anterior vitrectomy. In 8 eyes posterior optic capture was performed, 3 with and 5 without vitrectomy. The follow-up ranged from 1 to 4.5 years (mean: 2 years).Visually significant secondary cataract developed in all 5 eyes with intact posterior capsules and in the 4 eyes that underwent PCCC without vitrectomy and without posterior optic capture (i.e., the optic was left in the capsular bag). The optical axis remained clear in all 6 eyes that underwent PC IOL implantation with vitrectomy (with or without posterior optic capture). Initially, all optic capture cases without vitrectomy also remained clear, but after 6 months 4 out of 5 developed opacification.In this series posterior capsulorhexis with anterior vitrectomy was the only effective method of preventing or delaying secondary cataract formation in infants and children.

Retrospective comparison of techniques to prevent secondary cataract formation after posterior chamber intraocular lens implantation in infants and children

Purpose: To determine the effect of various methods of managing the posterior capsule and anterior vitreous on the rate of posterior capsule opacification in pediatric eyes implanted with posterior chamber intraocular lenses (PC IOLs).Setting: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.Methods: We reviewed the charts of 20 eyes of 15 children (aged 1.5 to 2 years) who had primary cataract surgery with PC IOL implantation during the past 5 years. The posterior capsule and anterior vitreous were managed in a variety of ways: In 5 eyes, the posterior capsule was left intact; in 15 eyes, a posterior continuous curvilinear capsulorhexis (PCCC) was performed-6 with and 9 without anterior vitrectomy; in 8 eyes, posterior optic capture was performed-3 with and 5 without vitrectomy. The follow-up ranged from 1 to 4.5 years (mean 2 years).Results: Visually significant secondary cataract developed in the five eyes with intact posterior capsules and in the four eyes that had PCCC without vitrectomy and without posterior optic capture (i.e., the optic was left in the capsular bag). The optical axis remained clear in the six eyes that had PC IOL implantation with vitrectomy (with or without posterior optic capture). Initially, all eyes that had optic capture without vitrectomy also remained clear, but after 6 months, four of five developed opacification.Conclusion: In this series, PCCC with anterior vitrectomy was the only effective method of preventing or delaying secondary cataract formation in infants and children.