Analysis and management of intraoperative and early postoperative complications of bag‐in‐the‐lens intraocular lens implantation in different age groups of paediatric cataract patients: report of the Giessen Paediatric Cataract Study Group

Abstract

Purpose To report the rate and management of intra‐ and early postoperative complications of bag‐in‐the‐lens intraocular lens (IOL) implantation technique for cataract treatment in paediatric patients of different age groups. Settings Department of Ophthalmology, Justus‐Liebig‐University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany. Design Retrospective non‐randomized consecutive case series. Methods Ninety eyes of 60 paediatric cataract patients were enrolled to this retrospective non‐randomized observational consecutive case series single‐centre study. All patients underwent cataract surgery with bag‐in‐the‐lens IOL implantation between January 2008 and December 2018, performed by two experienced surgeons. The entire cohort was divided into four age groups: first – 0–<3 months, second – 3–<12 months, third – 12–<36 and fourth – >36 months–17 years of age. The intra‐ and postoperative complications were based on the clinical records. The description of management of complications related specifically to bag‐in‐the‐lens IOL technique was based on the 39 consecutive cases operated since 1 Jan 2016 by one single surgeon that were all video documented. The early postoperative period was defined as 12 months after surgery. Results Overall, there were 27 unilateral and 33 bilateral surgical cases of 24 female and 36 male children. The mean age at surgery was 45.25 months (range 1–200 months). The most common intraoperative events were vitreous prolapse and anterior capsule rupture with 28.9% and 13.3%, respectively. Within 12 months of follow‐up, five eyes (5.6%) were re‐operated because of visual axis reo‐pacification (VAR). Intraocular hypertension was diagnosed in seven eyes (7.8%), including two cases that required surgical treatment. In all cases with intra‐ and early postoperative complications related specifically to bag‐in‐the‐lens technique, it was possible to manage them and successfully implant bag‐in‐the‐lens IOL. Conclusions Implementation of bag‐in‐the‐lens technique in the treatment of paediatric cataract was associated with a relatively low rate of intra‐ and postoperative complications, including rare cases of VAR. The correct management of complications related specifically to bag‐in‐the‐lens IOL implantation technique shall to be considered during the learning curve.

Bag‐in‐the‐lens intraocular lens in paediatric cataract surgery: intraoperative and postoperative outcomes

“…So far, there are no cases of secondary glaucoma or other complications. These favourable results are in accordance with the other studies on BIL surgery in paediatric cataract (Tassignon et al 2007;van Looveren et al 2015;Nystr€ om et al 2018;Bailleul 2020;Lytvynchuk et al 2020).…”

“…In the third patient with VAO in both eyes (Figure 2C and D), we think the reason for VAO development is related to short eyes and narrow Berger's space with insufficient separation of the posterior capsule from the anterior hyaloid membrane. It is interesting that both van Looveren et al (2015) and Lytvynchuk et al (2020) also concluded that in all their cases of VAO, the posterior capsule was not or no longer completely inserted into the IOL groove. (2) Because anterior vitrectomy is avoided in the BIL surgery, the anterior vitreous membrane is kept intact.…”

“…Nystr€ om et al ( 2018) experienced secondary glaucoma in 13.8% and VAO in 4.6% (median follow-up time 2.9 years, range 7 months to 5.8 years). Lytvynchuk et al (2020) had 2.2% of secondary glaucoma and 5.6% of VAO; however, their study included only the early postoperative period, defined as 12 months after surgery. The French group (mean follow-up time 3.3 years, range 0.25-9.4 years) reported 5.2% of VAO and no secondary glaucoma (Bailleul 2020).…”

“…In their most recent publication, 5-year data from 46 eyes (age at surgery 2 months to 14 years) are presented, showing VAO in four cases and glaucoma in one patient (van Looveren et al 2015). More recently, a Swedish group (Nystr€ om et al 2018;Nystr€ om et al 2020), a German group (Lytvynchuk et al 2020) and a French group (Bailleul 2020) have published their results with the BIL technique in paediatric cataract surgery. Nystr€ om et al ( 2018) experienced secondary glaucoma in 13.8% and VAO in 4.6% (median follow-up time 2.9 years, range 7 months to 5.8 years).…”

“…2020), a German group (Lytvynchuk et al. 2020) and a French group (Bailleul 2020) have published their results with the BIL technique in paediatric cataract surgery. Nyström et al.…”