Posterior Chamber Intraocular Lens Implantation in Pediatric Cataract with Microcornea and/or Microphthalmos

Abstract

PurposeTo report the results of secondary posterior chamber intraocular lens (PC-IOL) implantation in pediatric cataract eyes with microcornea and/or microphthalmos.MethodsRetrospective studies were conducted by reviewing the charts of 26 eyes of 15 patients with secondary PC-IOL implantations for microcornea and/or microphthalmos associated with cataract in children between 1999 and 2002. The corneal diameter was 9.5 mm or less at the time of secondary PC-IOL implantation. Preoperative examinations were conducted for bilaterality, corneal diameter, eye abnormalities and systemic abnormalities. Postoperative results were evaluated in terms of visual developments, refractive changes, axial length measurements and the occurrence of complications. The follow-up period was at least one year after secondary PC-IOL implantation.ResultsAge at the first diagnosis for cataract with microcornea and/or microphthalmos was 2.7 months on average. Among 15 patients, 8 (53.3%) had a family history. All patients received an initial irrigation and aspiration, posterior capsulectomy, and anterior vitrectomy at 0.8 years (0.1-3.3 years) of age and a secondary PC-IOL implantation surgery at 6.7 years (1.6-17.2 years) of age on average. The postoperative follow-up period was 2.1 years (1.1-4.3 years) on average. The average power of the implanted PC-IOL was +21.2D. Postoperative complications were secondary glaucoma in two eyes, secondary pupillary membrane formation in two eyes. Best corrected visual acuities in 20 eyes in children capable of the vision test at the last follow-up were 20/60 or better in 11 eyes, 20/80 to 20/150 in eight eyes, and 20/200 or worse in one eye.ConclusionsThe secondary PC-IOL implantation in pediatric cataract with microcornea and/or microphthalmos is recommended as a means of improving vision, but must be conducted carefully to avoid possible complications.

Implantation of glued intraocular lenses in eyes with microcornea

“…18 There are few reports of cataract surgery in eyes with microcornea, and there are no studies of the use of transscleral-fixated PC IOLs in eyes with zonular dialysis. 5,6,[19][20][21][22][23][24][25][26][27][28] Gimbel et al 19 reported inserting PC IOLs in bilateral microcorneas with corneal diameters of 9.43 mm and 9.61 mm and ALs of 19.29 mm and 19.23 mm to obtain a postoperative bilateral CDVA of 20/20. Dahan 20 reported that with unilateral congenital and developmental cataracts, a pediatric PC IOL can be inserted in the capsular bag unless the corneal diameter is less than 9.5 mm.…”

“…[1][2][3][4] The size of the surgical incision, mode of lens removal, type of intraocular lens (IOL) used, and method used to determine IOL power are modified for eyes with microcornea. 5,6 Microcornea can present alone or with syndromes, eg, microphthalmia (often) and macrophthalmia (rarely). [5][6][7] It might also be associated with developmental deformity in ciliary zonular fibers, which can cause lens subluxation and intraoperative zonular dialysis during cataract extraction.…”

“…5,6 Microcornea can present alone or with syndromes, eg, microphthalmia (often) and macrophthalmia (rarely). [5][6][7] It might also be associated with developmental deformity in ciliary zonular fibers, which can cause lens subluxation and intraoperative zonular dialysis during cataract extraction. Under such circumstances, IOL placement in the normal capsular bag might not be possible.…”

Surgical Outcome of Congenital Cataract in Eyes With Microcornea

“…The remaining 9 of the 12 (75%) bilateral cases used aphakic glasses. There have been reports of primary and secondary posterior chamber IOL implantation in eyes with microcornea [23][24][25][26] with relatively good visual outcomes. We implanted secondary IOLs in both eyes of two patients 3 years after the initial surgery.…”

Capsular Outcomes After Pediatric Cataract Surgery Without Intraocular Lens Implantation

“…1,2,18–20 In this cross-sectional study, we first qualitatively classified the capsular outcomes in aphakic eyes 12 months after pediatric cataract surgery into 3 types based on the degree and range of PCOO. We discovered that the types (scores) of capsular outcomes were negatively correlated with intraoperative anterior capsulorhexis size but had no significant correlation with intraoperative posterior capsulorhexis size.…”