Rate and Success of Secondary Procedures in Children after Primary Intraocular Lens Implantation
Bharti Nihalani-Gangwani; Deborah K. VanderVeen
Boston Children’s Hospital
Introduction: Young children have a high rate of visual axis opacification(VAO) after IOL implantation. Primary posterior capsulorhexis(PCCC) and anterior vitrectomy(AV) is recommended in children <= 6 years. Our objective was to determine the rate and success of secondary procedures in children with primary IOL implantation.
Methods: Database review of patients <18 years of age operated for cataract between 1998-2015 to evaluate timing and success rates of secondary procedures. Included patients with single piece Acrysof in the bag and minimum 1 year follow-up.
Results: 192 eyes of 130 patients were included. The mean age at primary surgery was 6.3 years (Range:8 months-18 years). 122 eyes (63.5%) had primary PCCC+AV and 70 eyes (36.5%) had intact posterior capsule (PC). At the last visit, with mean follow-up of 2.2 years, 50 eyes (26%) had required a secondary procedure: 10/122 eyes with primary PCCC+AV and 40/70 eyes with intact PC.. 34 eyes had YAG capsulotomy, which was successful in 76%. Surgical AV +/- capsulectomy was performed in 16 eyes with 94% success rate. Failure of YAG was noted in younger children who had dense fibrous proliferation. No significant complications were noted from either procedure type.
Discussion: VAO occurs in 57% eyes with intact PC by 2 years; YAG capsulotomy can be a successful procedure for older children. Surgical AV has a higher success rate and is often needed in younger children.
Conclusion: Patient age and type of VAO should be considered when planning for secondary procedures.
References: 1. Buckley EG, Klombers LA, Seaber JH et al. Management of posterior capsule in pediatric intraocular lens implantation. Am J Ophthalmol 1993;115:722-8
2. Stager DR Jr, Wang X, Weakley DR, Felius J. The effectiveness of Nd:YAG laser capsulotomy for the treatment of posterior capsule opacification in children with acrylic intraocular lenses. JAAPOS 2006;10:159-63)