Capsular Opacification after Vitreous-Sparing Cataract Surgery in Children

 

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Zusammenfassung

Hintergrund: Kapseltrübungen nach Hinterkammerlinsen-Implantation (HKL-Implantation) sind bei Kindern wegen Amblyopierisiko gefürchtet. Eine hintere Kapsulotomie mit vorderer Vitrektomie hat sich zur Reduktion der Nachstarbildung nach Kataraktoperation bewährt, geht hingegen mit einem erhöhten Risiko eines Sekundärglaukoms einher. Patienten und Methoden: Diese Studie untersuchte die Nachstarbildung in 73 Augen von afrikanischen Kindern, bei welchen eine HKL zwischen 1998 und 2001 unter Erhaltung des Glaskörpers implantiert wurde. Die Haptik der HKL wurde in allen Augen in den Kapselsack implantiert, davon die Optik in den Kapselsack ohne Kapsulotomie in 12, mit Kapsulotomie in 14 und in Kombination mit der Knopflochtechnik in 47 Augen. Resultate: Die Bildung von Elschnig-Perlen hing signifikant von der Knopflochtechnik (p < 0,001) und vom Alter des Kindes (p < 0,05), nicht aber von der Kapsulotomie (p = 0,084) und der Augenseite (p = 0,1) ab. Die Klarheit der Sehachse wurde signifikant von der Knopflochtechnik (p < 0,001), nicht aber von der Kapsulotomie beeinflusst. Schlussfolgerungen: Eine hintere Kapsulotomie verhindert keine zentrale Nachstarbildung nach Kataraktoperation und HKL-Implantation bei Kindern, wenn der Glaskörper erhalten wurde, außer in Kombination mit der Knopflochtechnik.

Abstract

Background: The aim of this study was to evaluate different methods of intraocular lens (IOL) implantation and posterior capsule management in the absence of vitrectomy with respect to visual axis opacification (VAO) in children. Patients and Methods: Seventy-three eyes of African children undergoing cataract extraction and IOL implantation between 1998 and 2001 were evaluated. In all eyes, the IOL haptics were placed in the bag and the vitreous was preserved. The IOL optic and posterior capsule were managed in the following 3 ways: The IOL optic was captured behind the posterior capsule in conjunction with posterior capsulotomy (PC) in 47 eyes (group 1). The IOL optic was implanted in the bag with PC in 14 eyes (group 2) and without PC in 12 eyes (group 3). Cox proportional hazard analysis and Kaplan-Meier survival curves were performed to evaluate the incidence of Elschnig pearls (EP) and VAO. Results: Elschnig pearls developed in 14.9 % of the patients in group 1, in 56.8 % in group 2 and in 91.7 % in group 3. The occurrence of EP depended significantly on optic capture (p < 0.001) and child’s age (p < 0.05), but not on PC (p = 0.084) and eye side (p = 0.1). The persistence of visual axis clarity depended significantly on optic capture (p < 0.001) but not on PC. Conclusions: In vitreous-sparing cataract surgery, posterior capsule opening does not effectively prevent VAO unless it is in conjunction with IOL optic capture.

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Matthias C. Grieshaber, MD, FEBO

Department of Ophthalmology, University Hospital Basel

Mittlere Straße 91

4031 Basel

Switzerland

Email: mgrieshaber@uhbs.ch