Long-Term Experience Utilizing Optic Capture Through a Capsular Buttonhole for Pediatric Cataracts
Stephen N. Lipsky, MD
Thomas Eye Group
Introduction: Capsular management is a significant concern with intraocular lens (IOL) use in pediatric patients. This study presents long-term experience and technical details for a procedure that yields a stable clear visual axis in pediatric IOL surgery.
Methods: This is a retrospective review of 58 eyes in 42 patients that underwent IOL implantation between 2005 and 2017. The prolene haptics are fixated in the ciliary sulcus and the 6.0mm acrylic optic is captured in a buttonhole of both the anterior and posterior capsules created with a vitrector.
Results: Mean age at surgery was 6.0 years (0.5-13) with mean follow of 43.2 months (3-139.2) and 38% bilateral. Cataracts treated included 83% congenital, 10% traumatic and 7% metabolic. There were no cases of opacification of the visual axis, contracture of the anterior or posterior capsule, iris chaffing, iritis or late IOL dislocation. One case required early IOL repositioning and IOL implantation was aborted in one case due to radial capsular tear.
Discussion: Buttonholing of the acrylic optic through the anterior and posterior capsule resulted in a stable and clear visual axis in all study patients. This single entry technique obviates the need for incisions through the pars plana and YAG capsulotomy. The technique is effective for secondary IOL implantation and in cases following trauma.
Conclusion: Capturing the IOL optic in a buttonhole consisting of anterior and posterior capsule is a technique that has a short learning curve, provides stable IOL fixation and a consistently clear visual axis in pediatric patients. The technical details will be described.
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3. Grieshaber MC, Pienaar A, StegmannR. Posterior vertical capsulotomy with optic entrapment of the intraocular lens in congenital cataracts: prevention of capsular opacification. J. Cataract Refract Surg. 2005 May;31(5):886.