Morphological and functional results of AcrySof intraocular lens implantation in children: prospective randomized study of age-related surgical management. Posterior continuous curvilinear capsulorhexis with and without optic capture of the posterior chamber intraocular lens in the absence of vitrectomy. Posterior capsule opacification after extra capsular cataract extraction in Indian rural population: foldable acrylic vs poly (methyl-methacrylate) intraocular lenses a randomized clinical trial. Long-term results of sealed capsule irrigation using distilled water to prevent posterior capsule opacification: a prospective clinical randomised trial. Randomised clinical trial of lensectomy versus lens aspiration and primary capsulotomy for children with bilateral cataract in south India. Heparin eyedrops to prevent posterior capsule opacification. Factors influencing the formation of posterior capsular opacities after extracapsular cataract extraction with posterior chamber lens implant. [Postoperative cataract following intraocular lenses with and without laser ridge]. Randomised controlled trial of anterior-chamber intraocular lenses.
To evaluate the prevalence and severity of posterior capsule opacification (PCO) in pediatric eyes with a foldable acrylic AcrySof (Alcon) intraocular lens (IOL) and age-related surgical methods.
                Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria.
                This prospective randomized study comprised 50 eyes of 34 children aged between 2 and 16 years. Eyes of children between 2 and 5.9 years were consecutively randomized to Group 1a (primary posterior capsulotomy and anterior vitrectomy) or Group 1b (optic capture in addition). Eyes of children between 6 and 16 years were consecutively randomized to Group 2a (primary posterior capsulotomy without anterior vitrectomy), Group 2b (optic capture in addition), or Group 2c (in-the-bag IOL implantation without opening the posterior capsule). Main outcome parameters were the incidence and severity of PCO formation, early postoperative complications, pigmented cell deposits on the IOL surface, and cataract morphology.
                The visual axis was clear at the last follow-up in all eyes in Groups 1a, 1b, 2a, and 2b except in 1 eye in Group 1a. Sixty-percent of eyes in Group 2c had PCO. The incidence of early postoperative complications was significantly higher in eyes that developed PCO than in those that maintained a clear visual axis. There was no evidence that cataract morphology influenced PCO rates.
                The AcrySof IOL was well tolerated in pediatric eyes. Optic capture was not necessary to ensure a clear visual axis. Primary posterior capsulotomy should be performed in preschool and uncooperative children and in eyes expected to have relatively high postoperative inflammation. Implanting the AcrySof in the bag and leaving the posterior capsule intact is acceptable for school children and juveniles with isolated developmental cataract. To evaluate the efficacy of posterior continuous curvilinear capsulorhexis (PCCC) with optic capture of the posterior chamber intraocular lens (PC IOL) in the absence of vitrectomy in preventing secondary opacification of the visual axis following pediatric cataract surgery.
                Thirty-four eyes of 28 children with congenital or developmental cataract, aged 1.5 to 12 years (mean, 6.39 years), were included in this prospective, randomized study. Anterior continuous curvilinear capsulorhexis (ACCC) with PCCC without optic capture of the PC IOL was performed in group A (18 eyes) and ACCC with PCCC with optic capture of the PC IOL was performed in group B (16 eyes). None of the eyes underwent anterior vitrectomy. Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed.
                The follow-up period ranged from 8 to 28 months (mean, 17.5 months). All 16 eyes (100%) in group B had a clear visual axis at the end of follow-up. Eight eyes (44.4%) in group A had significant opacification of the visual axis. The difference between the two groups was statistically significant (P = .0011). No eye in group B required secondary intervention, whereas all 8 eyes in group A with significant secondary opacification required secondary intervention. There was no statistically significant difference in other complications such as anterior chamber reaction, fibrin formation, lenticular precipitates, and posterior synechiae. The final best-corrected visual acuity at the end of follow-up was comparable in the two groups (P > .05).
                PCCC with optic capture of the PC IOL prevents secondary opacification of the visual axis even in the absence of vitrectomy. To compare the performance of single-piece acrylic vspoly (methylmethacrylate) intraocular lenses (IOL) on the development of posterior capsule opacification (PCO) after conventional extra capsular cataract extraction (ECCE).
                One hundred and eighty-two eyes of 91 patients with bilateral senile cataract undergoing ECCE were prospectively randomized to receive a single-piece Alcon AcrySof SA60AT IOL or a single-piece EPOCH polymethylmethacrylate IOL in the first eye to have surgery. At 1, 6 and 12 months post-operative follow-up, digital retro illumination images of the posterior capsule were taken for PCO assessment semi-objectively using PCO (POCO automated analysis software) system. Relationship of anterior capsule contact (total off and partial cover) on optic for PCO was analyzed.
                The AcrySof IOL was associated with less PCO than EPOCH lens at 6 months (10.01+/-8.75% vs 32.26+/-27.44%; P<0.001) and 1-year (11.65+/-10.55% vs 38.38+/-29.62%; P<0.001) follow-up. The EPOCH IOL showed a remarkably significant difference on development of PCO with anterior capsule overlap on IOL optic (total off and part on) 1 year (P<0.039), whereas no such difference was observed with the AcrySof IOL (P=0.197).
                The AcrySof IOL led to significantly less PCO than the EPOCH IOL post-operatively after extracapsular cataract extraction. We investigated long-term safety and efficacy of sealed capsule irrigation (SCI) during cataract surgery to prevent posterior capsule opacification (PCO).
                One eye of each of 17 patients (mean age: 70.1+/-9.7 years) who presented with bilateral cataracts was randomly chosen for SCI treatment. After phacoemulsification, the capsular bag was vacuum sealed with the PerfectCapsule device (Milvella) followed by SCI using distilled water for two minutes. No vacuum loss occurred during irrigation. Each patient's fellow eye served as a control. One hydrophilic acrylic intraocular lens model was implanted in all eyes. Five patients had to be excluded due to deep anterior chamber, small pupil or unilateral surgery. Follow-up examinations took place one day and one, three, six, 12 and 24 months after surgery. We evaluated safety parameters, anterior capsule (AC) overlapping and PCO.
                Postoperatively, mean best corrected visual acuity, pachymetry, endothelial cell count, intraocular pressure, AC overlapping and PCO showed no statistically significant difference between SCI and the control group (p>0.05, Wilcoxon test).
                SCI is a safe procedure and enables the specific pharmacological targeting of lens epithelial cells inside the capsular bag. Using distilled water, however, it is not possible to reduce PCO development significantly. Thus, alternative substances should be evaluated. The primary objective was to determine which surgical technique gave the best long term visual outcome for infants and young children with bilateral symmetrical cataract in south India. Secondary objectives were to assess complications and the need for further surgical intervention.
                A randomised controlled clinical trial was undertaken. 65 children under 10 years old with bilateral cataract had one eye treated by lensectomy and the other by aspiration with primary capsulotomy.
                56 children (86%) with a mean age at surgery of 53 months were reviewed 3 years after surgery. The overall binocular acuity was 6/18 or better in 57.1% and 6/60 or better in 94.6%. There was no difference in visual acuity between the matched pairs of eyes undergoing aspiration or lensectomy at the third year of follow up (p=0.57). Aspiration eyes were more likely to require a secondary procedure to restore vision than lensectomy eyes (66.1% v 1.8%).
                Aspiration with primary capsulotomy gives an acceptable visual outcome in this part of India providing that there is good follow up to manage capsule opacification. If secondary intervention is not possible owing to poor compliance with follow up, then lensectomy is likely to give better long term visual rehabilitation providing there is good maintenance and technical support for the lensectomy equipment. To evaluate whether heparin eyedrops prevent or reduce posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation.
                Institute of Ophthalmology, University G. d'Annunzio, Chieti, Italy.
                This 4 year, prospective, case-controlled study evaluated 200 patients who had ECCE and implantation of the same type of posterior chamber IOL. Patients were randomly assigned to receive topical heparin eyedrops postoperatively (heparin group, n = 100) or not to receive the eyedrops (control group, n = 100). Postoperative cell response, cellular precipitates on the IOL, and presence of PCO were evaluated.
                There were no significant differences between groups in postoperative inflammation. The incidence of cellular precipitates was significantly lower in the heparin group than in the control group (P < .001). A neodymium:YAG (Nd:YAG) posterior capsulotomy was done in 7 patients in the heparin group and 14 in the control group (P = .15). During the first 24 months after surgery, the heparin group had a significantly lower incidence of Nd:YAG capsulotomy (P < .05) and fibrotic PCO (P = .02).
                Topical heparin eyedrops were effective in reducing fibrotic PCO in the long term, indicating their usefulness in the postoperative management of ECCE. This study was designed to determine whether different factors could influence the formation of posterior capsular opacities. The study group comprised 271 patients who had undergone an extracapsular cataract extraction with implantation of a posterior chamber lens either with or without laser ridge. Between 12 and 25 months after surgery, a statistically significant difference was found with a lower rate of secondary cataract in the laser ridge group, but with respect to advanced secondary cataract, i.e. eyes which needed YAG capsulotomy, no statistically significant difference was found (P-value 0.99). No association was found between age or sex of patients, different surgeons or complications during or after surgery and the risk of getting a secondary cataract. In this randomized, prospective clinical study, a convex plane intraocular lens (IOL) with a laser ridge was compared with a convex plane IOL without a laser ridge. No difference was found in the reduction of capsular opacification 1 year after surgery. The 100 patients (40 males/60 females) with senescent cataracts were treated with ECCE by a single surgeon from November 1986 to March 1987. The operative technique consisted of capsulorhexis, irrigation-aspiration and in-the-bag-implantation. The first group of 50 patients (50 eyes) had an IOL without a laser ridge and the second group an IOL with a laser ridge. When considering after-cataracts in combination with minor visual deterioration we had secondary cataract rate of 15% in the IOL group with a laser ridge and of 16% in the IOL group without a laser ridge. When we considered only the cases in which visual acuity worsened and YAG laser capsulotomy was required, the secondary cataract rate was 1.5%. There are an estimated 16 million people blind in both eyes with cataracts. Most live in rural areas of developing countries where surgical resources are scarce. There is no consensus on the most appropriate type of intraocular lens in situations where high-volume low-cost surgery is required. This study was undertaken to evaluate the safety of multiflex open-loop anterior-chamber lenses (ACIOLs).
                2000 people attending Lahan Eye Hospital, southern Nepal, with bilateral cataracts reducing vision to 6/36 or less were randomly allocated to receive standard surgery--intracapsular extraction (ICCE) with aphakic correction--or ICCE with an ACIOL in their first operated eye. The primary outcome was a visual acuity of less than 6/60 in the operated eye at 1 year follow-up. Visual acuity was measured for 91% of the cohort at 1 year. The sample size was estimated to detect a doubling in poor visual outcome from an estimated rate of 4% in the standard surgery (control) group.
                The median (range) time taken to do the surgery was 6.0 (3.0-17.2) min for the ACIOL group and 4.1 (2.4-10.3) min for the control group. 1 year after surgery, 5.0% of the ACIOL group and 5.4% of controls had functional vision less than 6/60 (OR 0.93 [0.60-1.43], p = 0.71). The causes of poor vision in the ACIOL and control groups were: correctable refractive error (22 and 29), uveitis/secondary glaucoma (13 and two), endophthalmitis (four and seven), pre-existing eye disease (four and five), retinal detachment (none and four), cystoid macular oedema (two and none), corneal ulcer (one and one), and corneal decompensation (none and one).
                This study provides evidence that, in rural areas of developing countries, multiflex open-loop ACIOLs can be implanted safely by experienced ophthalmologists after routine ICCE, avoiding the disadvantages of aphakic spectacle correction. Further follow-up is planned.
Evidence exists for the care of children with congenital or developmental bilateral cataracts to reduce the occurrence of visual axis opacification. Further randomised trials are required to inform modern practice about other concerns including the timing of surgery, age for implantation of an intraocular lens and development of long-term complications such as glaucoma and retinal detachment.