Surgical Outcomes For Congenital Cataract Patients With Partial Defects Of The Posterior Capsule Or Posterior Lenticonus

To evaluate intraoperative complications and postoperative results of cataract surgery for congenital cataract patients with partial defects of the posterior capsule or posterior lenticonus.

Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

Cataract surgery was performed from 2018 to 2019 in four patients aged 3-4 years for seven eyes with congenital cataract, and a partial posterior capsule defect or posterior lenticonus. Mean preoperative logMAR visual acuity (VA) was 1.07±0.70 (± SD). First, a 25-gauge trocar for a vitrectomy was first placed, followed by a sclerocorneal incision, continuous curvilinear capsulorhexis, and ultrasonic phacoemulsification and aspiration. Ultrasound treatment was avoided as much as possible and efforts to aspirate the lens were made. Following an intraocular lens (IOL) insertion into the capsular bag, the posterior capsule and anterior vitreous membrane were circularly resected with a vitreous cutter to counteract secondary cataracts.

During surgery, after lens removal and aspiration, a partially defective posterior capsule was found in five eyes of three cases. Because of an anterior vitreous membrane present in the posterior capsule defects, we were careful to not inadvertently aspirate the vitreous membrane and IOL insertion into the bag was performed in all cases. However, in one eye, vitreous herniation in the incision wound was noted and additional vitreous removal performed. Postoperative logMAR VA was 0.55±0.60 at 12 months and 0.19±0.43 at 47.3±4.9 months, the final follow up, improvement from preoperative levels (both P<0.01, paired t-test). Only the unilateral case had a poor final logMAR VA of 1.15. Refraction at the final visit was -1.11 ± 1.79 diopters.

Even in congenital cataract cases with posterior capsule defects, if the lens can be carefully aspirated so as to avoid accidental aspiration of the anterior vitreous membrane, it is possible to fix the IOL in a capsular bag. Visual prognosis should be good except for unilateral cases.