The effect of retaining intact posterior capsule in congenital cataract surgery in children aged 4–8 years
Jing Shang ZhangJin Da WangMayinuer YusufuKai CaoShan JinYing XiongJing LiXiu SunShu Ying ChenZhen Yu LiuJing FuLi LiQi Sheng YouXiu Hua Wan
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Abstract Background The present study sought to observe the effect of retaining intact posterior capsule in congenital cataract surgery in children aged 4–8 years. Methods This is a retrospective case control study. Seventy-seven children (130 eyes) aged from 4 to 8 years who underwent cataract surgery were divided into two groups. In Group A, 50 eyes underwent phacoemulsification, intraocular lens implantation and posterior capsule capsulotomy combined with anterior vitrectomy. In Group B, 80 eyes underwent cataract phacoemulsification and intraocular lens implantation. The postoperative visual acuity and the rate of complications were compared. Results In all patients, cataract surgeries were performed evenly without intraoperative complications. The follow-up time ranged from 6 months to 42 months. No apparent visual axis opacity was detected in group A during the follow-up. By the last visit, apparent visual axis opacity was detected in 31 eyes (38.75%) in group B. Among them, 9 eyes (29.03%) with mild posterior capsule opacification (PCO) were treated with Nd:YAG laser, 3 eyes (9.68%) with thick proliferative membranes were treated with posterior capsule capsulotomy combined with anterior vitrectomy and proliferative membranes in 19 eyes (61.29%) were completely aspired and the posterior capsule was retained. During follow-up, only 2 (6.45%) eyes had PCO recurrence and were treated with Nd:YAG laser. The visual acuity was significantly higher than that before surgery in all patients. Conclusions For older children, the incidence of PCO will be low even if intact posterior capsule is retained. Either Nd:YAG laser or surgical treatment for PCO will be able to maintain good vision.Keywords:
Posterior Capsulotomy
Capsule
Posterior Capsule Opacification
Implantation in the capsular bag by experienced intraocular lens surgeons, for treatment of cataract in children, may be considered as a valid and secure alternative proposal to contact lenses and epikeratophakia. A comparative preliminary study shows the results of different techniques: primary implantation with secondary posterior YAG laser capsulotomy or implantation and primary posterior capsulotomy with or without anterior vitrectomy.
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Objective To study the clinical characteristics of the posterior capsule opacification(PCO) and the outcome of neodymium: yttrium aluminum garnet(Nd:YAG) laser posterior capsulotomy in children with pseudophakic eyes.Methods 207 children with 249 eyes(3～12 years old) performed phacoemulsification with posterior chamber intraocular lens(IOL) implantation,including 121 eyes with polymethylmethacrylate(PMMA) IOL(Group A) and 128 eyes with Acrysof IOL(Group B).The rate of PCO and the visual acuity of Nd:YAG capsulotomy were followed up for 12～84 months.Results There were significant differences in the percentages of PCO and the rate of Nd:YAG capsulotomy between two groups(P0.01).Group A was associated with more PCO(92.6%) than Group B(32.9%).The Nd:YAG capsulotomy rate was 92.6% for Group A,and 26.6% for Group B.Among 146 eyes who performed Nd:YAG capsulotomy,100% patients were relieved from blindness and 90.7% patients obtained corrected visual acuity≥0.3.Conclusion The results suggest that phacoemulsification with Acrysof intraocular lens implantation can effectively reduce the percentages of PCO and the rate of Nd:YAG capsulotomy in children with cataract aged 3～12 years old.The Nd:YAG capsulotomy is a safe and effective procedure to remove the PCO in children with pseudophakic eye.
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PURPOSE: To compare posterior capsule opacification (PCO) 3 years postoperatively in contralateral eyes with a single-piece hydrophobic acrylic and 1 of 2 single-piece hydrophilic acrylic intraocular lenses (IOLs) with different configurations. SETTING: Iladevi Cataract and IOL Research Institute, Ahmedabad, India. DESIGN: Prospective randomized clinical trial. METHODS: A hydrophobic Acrysof (hydrophobic group) or a hydrophilic C-flex (hydrophilic group C) or Akreos Adapt IOL (hydrophilic group A) was randomized for implantation in the fellow eye or vice versa of each patient. The Evaluation of Posterior Capsule Opacification (EPCO) area, EPCO score, and neodymium:YAG (Nd:YAG) capsulotomy rates were compared using digital photographs. RESULTS: The study enrolled 68 patients. Although there was no significant difference at 1 month, the median EPCO score was statistically significantly lower in the hydrophobic group than in hydrophilic group C (P=.00) and hydrophilic group A (P=.000) at 3 years. There were no significant differences in the median EPCO area at 1 month; however, the area was statistically significantly less in the hydrophobic group than in hydrophilic group C and hydrophilic group A at 3 years (both P=.000). Four (12.9%) of 31 eyes in hydrophilic group C and 5 (16%) of 31 eyes in hydrophilic group A required an Nd:YAG capsulotomy; no eye in the hydrophobic group required a capsulotomy (P=.04 and P=.02, respectively). CONCLUSION: Posterior capsule opacification was significantly less with the Acrysof hydrophobic acrylic IOL at 3 years. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.
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Objective
To evaluate and compare the subjective and objective visual quality of YAG laser posterior capsulotomy.
Methods
A series of case observation study was designed.Twenty-eight patients (38 eyes) underwent Nd: YAG laser posterior capsulotomy in the Eye Hospital of Wenzhou Medical University were retrospectively collected from 2015 to 2016.Patients were divided into circular capsulotomy group (20 patients 23 eyes) and cruciate capsulotomy group (12 patients 15 eyes) based on the capsulotomy technique (round incision of posterior capsule or cross incision of posterior capsule). The uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were examined before and 2 weeks after operation, the intraocular pressure was also measured before operation, 1 hour after operation and 2 weeks after operation.The Strehl ratio (SR), modulation transfer function (MTF) cut-off, objective scatter index (OSI), OQAS values (OVs) were analyzed by Two-channel visual quality analysis system OQAS Ⅱ at 1 h and 2 weeks after operation.The changes of intraocular scattering and visual quality at 1 h and 2 weeks after operation with different posterior capsulotomy methods were compared and analyzed.
Results
At 2 weeks after operation, the UCVA was 0.18±0.15 and 0.16±0.14, and the BCVA was 0.10±0.10 and 0.10±0.11, respectively in the circular capsulotomy group and cruciate capsulotomy group, which was higher than those before operation (all at P 0.05). There was no significant difference in intraocular pressure between the two groups at 1 hour and 2 weeks after operation (both at P>0.05). In the circular capsulotomy group, the incidence of black shadow drift was 39.1% and 30.4% respectively at 1 hour and 2 weeks after operation, which was higher than that in the cruciate capsulotomy group (6.7% and 6.7%), with no significant differences between the two groups (P=0.065, 0.177). No significant difference were found in the incidence of black shadow drift before eyes between the two groups (P>0.05), and there was no significant differences in the OQAS parameters OSI, MTF, SR, OV100%, OV20% and OV9% between the two groups (all at P>0.05).
Conclusions
After Nd: YAG laser capsulotomy, the incidence of black shadow drift in the cruciate capsulotomy group is lower than that in the circular capsulotomy group.There is no significant difference in the visual acuity, intraocular pressure, intraocular scattering and visual quality parameters between circular posterior capsulotomy and cross posterior capsulotomy.
Key words:
Scatter; Visual quality; Nd: YAG laser posterior capsulotomy; Capsulotomy technique; Posterior capsular opacification
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Purpose To compare the development of posterior capsule opacification (PCO) and survival rate without capsulotomy after implantation of a hydrophobic or hydrophilic acrylic intraocular lens (IOL) at the 9-year postoperative follow-up. Methods One of 3 experienced cataract surgeons performed standard phacoemulsification in one eye of 120 patients with cataract. The patients were randomized to implantation of either a hydrophobic acrylic IOL or a hydrophilic acrylic IOL. Both IOLs had sharp posterior edges. Retroillumination images of PCO were obtained with a fundus camera 9 years postoperatively and analyzed semiobjectively using POCOman computer software. Results Seventy-eight of the 120 patients completed the 9-year follow-up examination. Patients implanted with the hydrophilic IOL had significantly (p<0.001) more and denser PCO. The survival rate without Nd:YAG capsulotomy was significantly higher (p<0.001) in eyes with the hydrophobic IOL. Conclusions After 9 years, more and denser PCO developed in eyes with the hydrophilic IOL than the hydrophobic IOL. The survival rate without the need for capsulotomy was higher in eyes with the hydrophobic IOL.
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Posterior Capsule Opacification
Intraocular lenses
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We describe a technique for femtosecond laser-assisted bag-in-the-lens (BIL) intraocular lens (IOL) implantation. Anterior capsulotomy and lens division into small pieces are performed by the laser. A fluid-filled interface makes it possible to re-dock the laser to the eye for posterior capsulotomy after the eye has been opened for lens aspiration without complications. The integrated optical coherence tomography also visualizes the posterior capsule, allowing a centered central posterior capsulotomy for uncomplicated IOL positioning. In 31 patients, no complications were observed within a 1-month follow-up. Femtosecond laser-assisted cataract surgery facilitated the BIL technique.
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Objective To asses the effectiveness of early treatment of Nd:YAG capsulotomy in preventing posterior capsule opacification (PCO) in pediatric cataract sugrery.Methods The study comprised 8 eyes of 8 pediatric patients who had cataract extraction and intraocular lens implantation between 1998 and 1999.Posterior capsulotomy was performed by Nd:YAG within one week to ten days after the surgery.Results Patients age ranged from 5 years to 11 years.Men follow up was 10 months,ranged from 5 to 19 months.7 eyes had a clear visual axis alast follow up,one eye required the second Nd:YAG capsulotomy.The incidence of PCO required capsulotomy was 12.5%.Conclusion Early Nd:YAG capsulotomy was safe and effective.It is also a easy way.Long term follow up is need in this study.
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OBJECTIVE To evaluate the different results of posterior capsulotomy and integral posterior capsule in school aged cataract extraction. METHODS Children performed cataract extraction were divided into integrated posterior capsule group and posterior capsulotomy group. After operation a follow up was performed and the visual acuity and the changes of posterior capsule were observed in the children. RESULTS Constituent ratio of posterior opacification was 60 percents in the follow up at three months, and 96 percents at one year.Visual acuity was improved more in posterior capsule capsulotomy group than in integrated posterior capsule group at 6 months after the operations ( P 0 05). CONCLUSIONS Ratio of posterior capsule opacification was higher in the school aged children with integrated capsule after the cataract extraction. Posterior capsulotomy was one of efficacious techniques in the cataract extraction.
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