Sealed-bag technique for IOL implantation in children appears safe

This prospective, randomized study evaluated outcomes of two different techniques of IOL implantation in 14 children (mean age, 5.1 years) with bilateral congenital or developmental cataract.

All patients underwent anterior capsulorhexis, lens aspiration, posterior continuous curvilinear capsulorhexis (PCCC) and anterior vitrectomy. One eye of each patient was then implanted with a 3-piece foldable acrylic IOL in the capsular bag. The same type of IOL was implanted in the contralateral eye using the sealed-bag technique. In this method, the haptics of the IOL were implanted in the ciliary sulcus and the optic was captured through the PCCC.

After a mean follow-up of 22 months, the visual axis remained clear in all eyes. In addition, there was no significant difference between the two groups in BCVA, refraction, IOP or other complications. The authors conclude if it is not possible to implant the IOL in the capsular space or if another option is sought, they suggest the IOL haptics be implanted in the ciliary sulcus and the optic captured through the posterior capsular opening using the sealed-bag technique.

This technique is only applicable with the use of the 3-piece IOL with PMMA haptics since the 1-piece AcrySof IOL is not indicated for sulcus fixation. The authors stress that this technique does not serve as a substitute for anterior vitrectomy, which is mandatory to decrease the risk for PCO in pediatric cataract surgery.