Optic capture buttonholing may prevent secondary cataract after pediatric cataract surgery

A prospective, randomized clinical trial conducted in Germany investigated long-term complications after pediatric cataract surgery with implantation of a heparin-coated polymethyl methacrylate IOL and posterior continuous curvilinear capsulorrhexis (PCCC) with anterior vitrectomy vs PCCC without anterior vitrectomy with optic capture buttonholing.

Study design

Fifty-eight eyes (41 patients; mean age 66 months) with unilateral or bilateral congenital cataract without previous surgeries or additional pathologies were randomly assigned to one of the surgery groups. The primary outcome measures were posterior capsule opacification (PCO), complication rates, and refractive error.

Outcomes

The mean postoperative follow-up period was 6.5 years. During that time, the primary outcomes were statistically insignificant between the 2 groups. However, 2 eyes in the anterior vitrectomy group developed secondary cataract, compared with no eyes in the optic capture buttonholing group.

Limitations

The study did not examine subgroups based on age. This could be important because PCO rates would be expected to be greater in younger patients. A comparison of the 2 techniques between eyes in bilateral cases also could have been informative.

Clinical significance

Further clinical studies with long follow-up periods and attention to surgical technique, IOL design, and materials are necessary, but this study showed posterior optic buttonholing to be a safe and effective alternative to anterior vitrectomy in pediatric cataract surgery.