Investigators prospectively compared the safety profiles of 2 IOL implantation techniques in children younger than 4 years old.
The cohort comprised 61 children undergoing cataract surgery who were randomized to a standard in-the-bag IOL with anterior vitrectomy, or optic capture of an IOL without vitrectomy. Visual axis obscuration (VAO), glaucoma, cell deposits on the IOL and posterior synechiae were assessed at 1, 3, 6 and 12 months.
After 1 year, rates of cell deposits and posterior synechiae were comparable between groups. In the standard group, however, 1 eye developed VAO and 2 developed glaucoma.
Optic capture could not be completed in 5 eyes (16.1%). Of these, 3 had a posterior capsule plaque that prevented an adequately sized posterior continuous curvilinear capsulorhexis (PCCC), and 2 had an inadvertently large PCCC. IOL placement was successfully achieved using other techniques; no eye in this group developed significant VAO, glaucoma or inflammation.
The small cohort and short follow-up period prevented the study from capturing the main advantages of each technique. Additionally, rates of glaucoma and VAO were not statistically different.
The optic capture technique requires the surgeon to create a hyaloid sparing, appropriately sized and centric PCCC, though there is significant forgiveness for each parameter.
Despite its limitations, this study is very important for pediatric cataract surgeons. Optic capture could be a promising alternative to the standard surgical technique, and might eliminate the additional step of anterior vitrectomy and any associated morbidity. While it requires a significant learning curve, optic capture is a technique worth adding to every surgeon's armamentarium.