Application Of Intraocular Lens Optic Capture Technique In Pediatric Cataract Surgery

Objective To evaluate the efficacy,safety,postoperative visual outcomes and complications of intraocular lens(IOL)optic capture technique in the treatment of congenital cataract in children and congenital microphthalmos with congenital cataract in children.Methods This retrospective study was conducted to summarize the clinical data of 41 children(67 eyes)with pediatric cataract who underwent IOL optic capture surgery from March 2011 to July 2016 in the Ophthalmological Center of Shandong Provincial Hospital Affiliated to Shandong University.Of all the patients,30 cases(47 eyes)were diagnosed as pediatric cataract with normal axis(normal ocular axis eyes with IOL optic capture group),11 cases(20 eyes)were congenital microphthalmos(the diagnostic criteria were 2 standard deviations of axial length of eye axis less than normal age group)combined with congenital cataract(short ocular axis eyes with IOL optic capture group)and 34 cases(54 eyes)were pediatric cataract with in-the-bag IOL implantation(normal ocular axis eyes with in-the-bag IOL implantation group).Inclusion criteria were as follows:(1)Total cataract or axial opacities of the lens that were large enough to obscure the visual axis;(2)Primary limbal tunnel incision at 12 o’clock,extracapsular lensectomy with/without anterior vitrectomy and with/without intraocular lens(IOL)implantation;(3)early postoperative optical correction for the aphakic eyes and aggressive postoperative patching of the sound eye.At all postoperative follow-ups,routine examination including visual acuity,IOP,anterior segment,fundus,A/B-mode ultrasound and mydriasis examination were performed.Chloral hydrate(CH)combined with topical Alcaine was usually used for the routine eye examinations of young children.The preoperative and postoperative data such as age,sex,eye,postoperative refraction and BCVA,and postoperative complications were recorded and analysed.SPSS22.0 was used for statistical analysis,one-way ANOVA,T test,Chi-square test and Fisher exact test.A value of P<0.05 was considered to be statistically significant.Results The mean age of patients at IOL implantation was 27.36±14.74(10-72 months)and the mean follow-up time was 21.40±11.66 months(6-52 months)in normal ocular axis eyes with IOL optic capture group.The mean age of patients at IOL implantation was 29.75±14.34(16-69 months)and the mean follow-up time was 27.30±11.27 months(16-47 months)in short ocular axis eyes with IOL optic capture group.The mean age of patients at IOL implantation was 33.17±17.15 months(15-75 months)and the mean follow-up time was 21.63±11.82 months(6-55 months)in normal ocular axis eyes with in-the-bag IOL implantation group.In the present study,6.61%(8/121)of 121 eyes(75 cases)obtained a BCVA better than or equal to 0.1 LogMAR,12.40%(15/121)obtained a BCVA between 0.3 LogMAR and 0.1 LogMAR,17.36%(21/121)obtained a BCVA between 0.5 LogMAR and 0.3 LogMAR,47.11%(57/121)BCVA between 1 LogMAR and 0.5 LogMAR,and 16.53%(20/121)BCVA poorer than 1 LogMAR.Of all the 121 eyes,monocular IOL implantation in 29 eyes and binocular IOL implantation in 92 eyes.At the end of the follow-up,there was no significant difference in BCVA(0.64 ±0.29)between monocular IOL implantation eyes and binocular IOL implantation eyes(0.72±0.31)(P=0.237).And 58 eyes underwent primary IOL implantation and 63 eyes underwent secondary IOL implantation.At the end of the follow-up,BCVA in the primary IOL implantation eyes was 0.62 ±0.30,and that in the secondary IOL implantation group was 0.79±0.30.BCVA in the primary IOL implantation group was better than in the secondary IOL implantation eyes(P = 0.002).The incidence of postoperative PCO in normal ocular axis eyes with IOL optic capture group was significantly lower than that in normal ocular axis eyes with in-the-bag IOL implantation group(P<0.05).The incidence of IOL decentration in normal ocular axis eyes with IOL optic capture group was lower than that in normal ocular axis eyes with in-the-bag IOL implantation group(P<0.05).There was no significant difference in the incidence of postoperative posterior synechia and the incidence of IOL surface deposits among the three groups(P>0.05).Conclusion1.IOL optic capture technique can be used for the treatment of congenital cataract in children with normal axis and short axis.This method can alleviate many worries caused by mismatch of IOL size and small capsule size in congenital microphthalmos with congenital cataract in children,and improve the postoperative visual acuity of congenital microphthalmos with congenital cataract in children.2.PCO is still one of the most common postoperative complications of cataract in children.Compared with in-the-bag IOL implantation technique,IOL optic capture technique can reduce the incidence of PCO and IOL decentration after congenital cataract surgery in children.