Comparison of epilenticular IOL implantation vs technique of anterior and primary posterior capsulorhexis with anterior vitrectomy in paediatric cataract surgery

Abstract

Purpose To compare the functional outcome of epilenticular intraocular lens (IOL) implantation vs the technique of anterior continuous curvilinear capsulorhexis (ACCC), posterior continuous curvilinear capsulorhexis (PCCC) with vitrectomy and in-the-bag IOL implantation in paediatric cataract surgery. Methods Forty eyes of 33 children with developmental or traumatic cataract, whose mean age was 2-12 years, were randomly divided into two groups A and B. Group A patients underwent epilenticular IOL implantation while in group B patients, ACCC, PCCC with anterior vitrectomy with in-the-bag IOL implantation was performed. Equal number of eyes (10 each) with developmental cataracts (subgroups A1 and B1) and traumatic cataracts (subgroups A2 and B2) were allotted to both the groups. Postoperative visual acuity, opacification of the visual axis, and possible complications were observed and analysed. Results Four eyes in subgroup B2 had fibrous or ruptured capsules, and were managed by epilenticular IOL implantation technique. One eye in subgroup B2 developed central posterior capsular opacification and hence required a secondary capsulotomy. All cases in group A maintained a clear visual axis at the last follow-up. Minimal postoperative inflammation was noticed in all groups, which subsided with anti-inflammatory medication.At the last follow-up, all eyes in group A gained visual acuity Z6/18. Whereas in group B, visual acuity Z6/18 was obtained in 85.7% cases with the epilenticular IOL implantation technique and in 83.3% cases with ACCC and PCCC with anterior vitrectomy technique. Conclusion Epilenticular IOL implantation offers a safe and effective alternative for management of paediatric cataract. In selected cases of traumatic cataract, it is the preferred treatment modality.

Maximizing the visual outcome in traumatic cataract cases: The value of a primary posterior capsulotomy and anterior vitrectomy

“…[ 16 ] and Rastogi et al . [ 17 ] They reported similar results, but only in pediatric subjects; furthermore, no control group was included. Shah et al .…”

Causes, epidemiology, and long-term outcome of traumatic cataracts in children in rural India

“…[15] Another study from India comparing traumatic cataract surgery with and without posterior capsule management had demonstrated that AV + PPC had a beneficial effect on visual acuity ( P = 0.001) and prevented further intervention. [19] This study showed that a significant number of children with intact posterior capsule may develop visually significant PCO even after placement of square-edge IOL in the capsular bag. Eyes with PCO in our study had similar vision than those without, as PPC + AV was done in very young children who had poorer vision.…”

All about traumatic cataracts: narrative review

“…35,36 Several studies have assessed the efficacy of posterior capsulectomy and anterior vitrectomy in pediatric TC and reported a positive effect on the visual outcomes. [48][49][50][51][52] Hence, performing posterior capsulectomy during surgery is recommended in children. This is not just because of the elevated risk of secondary visual axis opacification development in children, who might not be cooperative for a postoperative YAG capsulectomy (YLC), but also because of the presence of an exceptionally dense capsular membrane.…”