Visual outcomes and complications of posterior chamber intraocular lens implantation in the first year of life

Purpose: To document the visual outcome and postoperative complications in infants who had congenital cataract surgery with posterior chamber intraocu lar lens (PC IOL) implantation in the first year of life. Setting: The Children's Hospital, Dublin, Ireland. Methods: Twenty-seven eyes of 20 infants were reviewed, Seven infants (14 e yes) had bilateral congenital cataract and 13 (13 eyes), uniocular cataract . The mean age at surgery was 4 months (range 3 weeks to 11 months). A stan dard surgical technique involved anterior capsulorhexis, phaccemulsificatio n with or without posterior capsulorhexis with in-the-bag PC IOL implantati on, and no anterior vitrectomy, Surgery was performed by 1 surgeon. The mea n follow-up was 41 months (range 6 to 88 months), Results: The main complication was lens reproliferation into the visual axi s, Of the 11 eyes that did not have a primary posterior capsulorhexis, 10 h ad 1 or more capsulotomies. Seven required a neodymium:YAG (Nd:YAG) laser c apsulotomy a mean of 6 months postoperatively, and 2 had 2 Nd:YAG capsuloto mies. Six eyes also had a surgical capsulotomy when the membrane was deemed too thick for further laser treatment. Fourteen of 25 eyes had a primary p osterior capsulorhexis; 8 had no further intervention. Four eyes had persis tent hyperplastic primary vitreous (PHPV), 3 required a surgical capsulotom y, 2 had an Nd:YAG laser capsulotomy, 2 had an anterior vitrectomy, and 1 d eveloped open-angle glaucoma. There was a mean refractive shift of 6.0 diop ters after a mean follow-up of 41 months, with most of the myopic shift occ urring in the first 24 months. Conclusions: Visual axis reopacification was the main complication of IOL i mplantation in infants, with PHPV leading to more complications and repeat procedures, Anterior vitrectomy appeared to reduce the reoperation rate. Re sults indicate that primary posterior capsulomexis is important and Nd:YAG capsulotomy is not satisfactory in infants. In addition, the reduction in g laucoma with IOL implantation, if borne out over the long term, is a signif icant advantage in cases of congenital cataract. (C) 2001 ASCPS and ESCPS.