Established plaque removal techniques work well in pediatric cataract surgery

The authors of this prospective study evaluated the incidence and management of posterior capsule plaque in pediatric eyes with cataract. They found that posterior capsule plaque was common, especially in those with a mature white cataract. After plaque peeling or removal with a vitrectome, the implanted IOL was stable in the capsular bag and the visual axis clear in most cases.

Their evaluation of 475 consecutive patients (670 eyes) between the ages of one month and 15 years who underwent cataract surgery found a 13.4 percent incidence of posterior capsule plaque. Of the 90 eyes with plaque, 70 had total white mature cataract and 20 had posterior subcapsular cataract.

This study was not designed to assess the efficacy of the techniques used in eyes with coexisting posterior capsule plaque. Rather, it was to assess the postoperative outcomes when the same experienced surgeon performed the procedures.

The surgeon performed plaque peeling in 41 eyes (45.5 percent) and partial excision of the plaque with a vitrectome in 49 eyes (54.4 percent). Fifty-four of the eyes implanted with an IOL (90 percent) had in-the-bag implantation and six (10 percent) had ciliary sulcus implantation. After a mean of 24 months, there was no IOL decentration. Visual axis obscuration developed in six eyes (6.7 percent). This rate of axial opacity presumably would have been zero if the surgeon had optic-captured into Berger's space.

The authors prefer manual capsulorhexis for plaque peeling because it has a lower risk of capsule tearing and produces a smooth, regular edge. It offers greater capsular bag stability and thus facilitates IOL implantation. However, they say that larger plaques require partial excision with a vitrectome.

The authors conclude that the increased incidence of plaque in eyes with white mature cataract may be the result of longstanding, exaggerated and advanced biochemical changes that cause epithelial cells to undergo fibrous metaplasia. that longer term studies with a larger sample size, possibly comparing eyes with and without posterior capsule plaque that are undergoing congenital cataract surgery, are needed to determine whether posterior capsule plaque contributes to the formation of visually significant posterior capsule opacity.