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Bag-in-the-lens IOL effective in pediatric cataract patients
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PARIS — Bag-in-the-lens IOL implantation can treat congenital or traumatic cataract in pediatric patients, according to the results of a study carried out between 1999 and 2007 by Marie-José Tassignon, MD.
The bag-in-lens IOL features a unique design, with two round haptics surrounding the optic, and a consequently unique technique of implantation, in which, after anterior rhexis and posterior rhexis of identical sizes are made with the help of a precalibrated ring, both the anterior and posterior capsule are positioned inside a fine groove that lays between the haptics. The lens has proven over the years to be stable and to create a good barrier against cell migration, thus preventing posterior capsule opacification, Dr. Tassignon said here at the meeting of the French Society of Ophthalmology.
She presented the results of a study on pediatric patients that included 54 eyes of 37 children between 2 months and 14 years. Nineteen cataracts were bilateral. Patients were divided into groups according to age: 0 to 1 year, 1 to 6 years and 6 to 15 years.
"Results are not uniform, due to the difficulty of measuring refraction in children less than 3 years of age," Dr. Tassignon said.
During follow-up, there were no cases of secondary cataract.
"The technique doesn't allow epithelial cells to migrate into the capsule, which is sealed and within the lens haptic," she said.
Best results were obtained in 22 children (35 eyes) older than 6 years in whom visual acuity improved from 20/100 to 20/25. If cataract was bilateral, visual acuity approached 20/20. Mean postoperative spherical equivalent was –0.5 D. Worst results, with a final visual acuity of less than 20/40, were obtained in five eyes due to persistent primary hyperplastic vitreous (one eye), amblyopia in cases of unilateral cataract (three eyes) or acid burn (one eye).
No cases of capsule rupture occurred because this particular lens creates a good equilibrium of forces within the capsule, Dr. Tassignon said.
Dr. Tassignon said she strongly recommends the use of this technique in pediatric patients. In cases of unilateral cataract it allows, depending on age, fast recovery or prevention of amblyopia. Vision is excellent, and enough accommodation is retained to allow most children to read without spectacles.