Bag-in-the-lens intraocular lens implantation in pediatric cataract

Abstract

Congenital cataract is the most common cause of treatable childhood blindness and remains a very important and difficult problem to manage. The timing of treatment is crucial to the visual development and successful rehabilitation of children before development of stimulus-deprivation amblyopia, strabismus and nystagmus. Currently, there is no consensus on the ideal postoperative target refraction in infants and children after surgery, and IOL power calculations for every young eyes can be particularly challenging due to the inaccuracies in the measurement of the axial length and corneal curvature so the choice of the IOL power should be individualized based on the child’s need and the refractive status of the other eye in unilateral cases. The pediatric eyes are different in comparison with the adult eyes so they need special operative considerations while performing cataract surgery including suture closure of tunnel wounds and paracentesis openings, and replacing the classic ACCC by alternative methods like vitrectorhexis, radio frequency and Fugo plasma blade. Management of the posterior capsule significantly affects the outcome of pediatric cataract surgery. Primary PCCC and vitrectomy are considered routine surgical steps in pediatric cataract due to the rapid and virtually inevitable PCO when adult-style cataract surgery is performed leaving the posterior capsule intact. There are other techniques to deal with the posterior capsule including optic capture technique, which should be combined with PCCC and anterior vitrectomy in children younger than 5 years, and posterior vertical capsulotomy with optic entrapment which has proven to be effective in maintaining a clear central visual axis, and seldomly requires anterior vitrectomy as a part of the procedure. Newer approaches to posterior capsule management are available such as pars plicata PCCC,SCI and BIL IOL implantation technique. The BIL IOL has a special design in which a 5 mm optic is surrounded by a peripheral groove defined by the elliptical haptics, and the optic and the haptic are perpendicularly oriented to each other. Bag in the lens IOL implantation technique requires creating ACCC and PCCC and inserting both in a groove