Congenital Cataract Extraction With Iol Implantation In Bag Vs Posterior Optic Capture, Our Favourite Technique?

Congenital cataract can be one of the most challenging conditions as improper management can lead to long term visual morbidity for patients. Cataract extraction followed by posterior capsulorhexis and anterior vitrectomy are well known steps taken to ensure a clear visual axis for patients but it is still debatable whether posterior optic capture poses a lower risk of visual axis opacification compared to IOL implatation in the in bag. we aim to describe our own experience with in bag IOL implantation vs posterior optic capture as regards PCO formation and IOL stability.

EyeCare Hospital, Cairo, Egypt. Cataract and refractive surgery department.

20 eyes of 10 patients underwent cataract extraction for bilateral congenital cataract. The mean patient age was 8 months. All 20 eyes underwent cataract extraction through a 2.4 mm limbal incision. Posterior capsulorhexis & anterior vitrectomy were performed for all eyes. The 1st group consisting of 12 eyes underwent IOL implantation in the capsular bag. The 2nd group consisting of 8 eyes underwent posterior optic capture. All eyes underwent single-piece hydrophobic acrylic intraocular lens implantation. There were no intraoperative complications for any of our patients.

2 patients underwent iol implantation in bag in one eye and posterior optic capture in the other eye. The remaining 8 patients had the same procedure done for both eyes.

1-day, 1 month and 6 months postoperative follow-up of all patients showed a clear visual axis and well centered IOL in all 20 eyes. 1 year postoperative examination after pupil mydriasis also showed a clear visual axis in all 20 eyes. There were no significant signs of Visual axis opacification in any of the eyes. 

2 year follow-up of 2 eyes of one patient who underwent iol implantation in the bag in one eye and posterior optic capture in the other eye also showed no visual axis opacification. both eyes showed a well centered IOL with postoperative refraction +2.25/-2.00 x 180 in the first eye and +3.00/-3.25 x 175 in the second eye.

Congenital cataract is a serious vision-threatening condition that requires proper and fast surgical management. Proper anterior and posterior rhexis size, proper choice of IOL and proper anterior vitrectomy are the gold standards to ensure a clear visual axis over the long term. In-the-bag IOL implantation and posterior optic capture are 2 known implantation techniques in congenital cataract, and the latter has been promoted to decrease PCO significantly on the long term. In our hands, there was no significant difference in regards to the clarity of the visual axis and IOL stability between both techniques. We continue to follow up our patients for a better understanding and evaluation of other parameters that may affect visual outcomes