Postoperative Outcomes of in-the-Bag IOL Implantation Versus Posterior Optic Capture in Pediatric Cataract Surgery: Randomized Clinical Trial
Purpose
To compare visual axis obscuration (VAO) and complications in children up to 4 years of age undergoing cataract surgery with IOL implantation using two IOL implantation techniques- in the bag IOL with anterior vitrectomy versus posterior optic capture of IOL without anterior vitrectomy.
Methods
Prospective, randomized, controlled clinical trial in 61 eyes (61 children) undergoing cataract surgery with IOL implantation randomized to Group I (n=30)-In the bag single piece hydrophobic acrylic IOL with anterior vitrectomy, or Group II (n=31)-Posterior optic capture of 3 piece hydrophobic acrylic IOL without anterior vitrectomy. Children were stratified based on age at surgery:<1 year, and >1 year to<4 years. Intraoperatively, complications and inability to implant the IOL as per plan were documented. Postoperatively,VAO, glaucoma, cell deposits on IOL(graded on slitlamp),presence and extent of posterior synechiae were compared between groups at 1,3,6 and 12 months. Number of eyes needing membranectomy/vitrectomy for VAO were documented. Eyes where optic capture could not be achieved were excluded from analysis.
Results
Mean age in Groups I and II was: 12.3+12 and 17.8+14 months. In 5 eyes in Group II (16%),IOL could not be captured due to posterior capsule plaque or large posterior capsulorhexis. No eye had sulcus IOL implantation. Only 1 eye in Group I required membranectomy for VAO at 7 months follow-up. No eye in either group developed glaucoma until 12 months. 9(30%) and 8(31%) eyes in Groups I and II respectively had >grade 2 small cell deposits at 1 month(p=1.0);1 eye in each Group had large cell deposits >grade 2 at 1 month and 12 months. Follow-up is ongoing, results will be updated later.
Conclusion
Optic capture could be achieved in most eyes without posterior capsule plaque. Although no anterior vitrectomy was performed in the optic capture group, there was no VAO, glaucoma or significant inflammation until 12 months follow-up. Optic capture of IOL may potentially eliminate the need for anterior vitrectomy even in very young eyes.