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Long-term outcomes of posterior optic capture show advantages in young children
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LISBON, Portugal — Posterior optic capture, whenever possible, is an alternative technique that can avoid vitrectomy as well as visual axis obscuration even in children younger than 4 years, according to one speaker.
“In-the-bag implantation with [posterior continuous curvilinear capsulorrhexis] and anterior vitrectomy is today the standard of care for children younger than 3 to 4 years. However, vitrectomy at this young age increases the risk of glaucoma and affects growth. You enter in the pars plana region that is not yet fully developed at this age,” Vaishali Vasavada, MS, said at the European Society of Cataract and Refractive Surgeons meeting.
In a study supported by the ASCRS Foundation, 61 eyes of 61 children from 0 to 4 years were randomly assigned to cataract surgery with posterior optic capture vs. standard in-the-bag implantation. The follow-up was up to 3 years. Subgroup analysis was performed for children below the age of 1 year, the peak group for posterior capsule opacification formation.
Up to 3 years, only one eye in the cohort developed visual axis obscuration, and this eye was in the in-the-bag implantation group. Cell deposits, which are a marker of inflammation, were slightly more in this group. Glaucoma developed in two eyes in the in-the-bag group and in none of the children who had posterior optic capture. Both children were younger than 7 months of age.
“This is not a technique you can perform in every eye. Posterior capsule plaque or an inadequate [posterior continuous curvilinear capsulorrhexis] size might preclude it, as it happened also in five cases in our study. It is a technique with a learning curve, and it is skill-dependent. But it allows sparing the vitreous and [visual axis obscuration],” Vasavada said.
Today’s evolution of IOL technology and developments of the technique such as Menapace’s posterior optic buttonholing and Tassignon’s bag-in-the-lens may also enhance results, she said. – by Michela Cimberle
Reference:
Vasavada V, et al. Long-term postoperative outcomes of IOL implantation in-the-bag vs. optic capture in children up to 4 years of age: randomized, clinical trial. Presented at European Society of Cataract and Refractive Surgeons meeting; Oct. 7-11, 2017; Lisbon, Portugal.
Disclosures: The authors report no relevant financial disclosures.