Lensectomy Without Intraocular Lens Implantation
In children who will be left aphakic, lensectomy is done through a small peripheral corneal, limbal, or pars plana incision with a vitreous-cutting instrument (vitrector). Irrigation can be provided by an integrated infusion sleeve or by a separate anterior chamber cannula. Ultrasonic phacoemulsification is not required, as the lens cortex and nucleus are generally soft in children of all ages. Removing all cortical material is important because of the propensity for reproliferation of pediatric lens epithelial cells. Tough, fibrotic plaques (eg, in severe PFV) may require manual excision with intraocular scissors and forceps.
Because posterior capsule opacification occurs rapidly in young children, a controlled posterior capsulectomy and anterior vitrectomy should be performed at the time of cataract surgery. This technique allows rapid, permanent establishment of a clear visual axis for retinoscopy and prompt fitting and monitoring of the aphakic optical correction. If possible, sufficient peripheral lens capsule should be left to facilitate secondary posterior chamber IOL implantation later.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.