Surgery Of Bilateral Infantile Cataract Complicated By Dysgenesis Of Posterior Capsule.

To present a case study of patient with bilateral partial cataract with complicated intraoperative course caused by dysgenesis of the posterior capsule.

Various ocular anomalies are a common finding in children with congenital cataract. These can contribute to several peri- and postoperative complications, that may require further surgeries. One of the common perioperative complications is a defective posterior capsule, which may cause difficulties in placement of the intraocular lens or its’ stability postoperatively.

Ophthalmology clinic of the 2nd Medical Faculty, Charles University in Prague, and the Faculty Hospital Motol

Patient with bilateral posterior subcapsular cataract and high hyperopia (+ 11.0 dpt in both eyes) diagnosed at 4 years of age was first treated with conservative approach due to good visual functions (UCDVA OD 0.25, OS 0.32, UCNVA OD 0.40, OS 0.50). With conservative therapy there was improvement of vision (BCDVA ODS 0.40, BCNVA OD 0.63, OS 0.80). At 7 years of age, he was indicated for cataract surgery because of impairment of vision (BCDVA OD 0.40, OS 0.16, BCNVA OD 0.32, OS 0.10). A dysgenesis of posterior capsule in form of fenestrum was detected during surgery and a three-piece IOL was implanted into the sulcus. On the first day post-surgery a subluxation of the IOL was detected, therefore the IOL was explanted and a rigid IOL with iris fixation was implanted into posterior chamber. During surgery of the second eye, the same dysgenesis of posterior capsule was detected and a three-piece IOL was implanted into the sulcus with optic capture behind anterior capsulorhexis as planned, the IOL was stable at the end of surgery. On the first day post-surgery a complete luxation of the IOL into the vitreous was detected. It appeared that the capsular zonules were deficient and the IOL luxated through the zonules. The IOL was again explanted and a rigid IOL with iris fixation was implanted. After stabilization post-surgery, there was an improvement of vision in both eyes (BCDVA OD 0.50, OS 0.40, BCNVA OD 0.50, OS 0.40), subjectively the patient perceived significant improvement.

Posterior subcapsular cataract can be combined with dysgenesis of posterior capsule in the form of weakened or completely missing capsule, which may not be apparent during patient’s examination. If the IOL cannot be placed in the bag, other possibilities should be considered. With sufficient capsular support, the IOL can be placed into the sulcus, placing the optic behind capsulorhexis. Without the capsular support, using the IOL with iris fixation appears to be a suitable option in pediatric patients.