Clinical Characteristics and Surgical Safety in Congenital Cataract Eyes with Three Pathological Types of Posterior Capsule Abnormalities

Xixia Ding, Linfeng Xiang, Qianwei Wang, Dandan Wang, Pingjun Chang, Zhangliang Li, Yinying Zhao, Feixue Chu, Chao Ma, Yun-E Zhao, Xixia Ding, Linfeng Xiang, Qianwei Wang, Dandan Wang, Pingjun Chang, Zhangliang Li, Yinying Zhao, Feixue Chu, Chao Ma, Yun-E Zhao

Abstract

Purpose: To observe the clinical characteristics of 3 pathological types of posterior capsule abnormalities (PCAs) in congenital cataracts (CCs) and evaluate the surgical safety in these eyes.

Methods: This study involved 239 children (367 eyes) with CC who underwent cataract surgery at the Eye Hospital of Wenzhou Medical University. All surgery videos were collected for detailed reviews. Intraoperative and postoperative complications (within 3 months) were all recorded.

Results: The 3 pathological types of PCAs, namely, persistent fetal vasculature (PFV), posterior capsule defect (PCD), and posterior lenticonus (PLC), presented in 129 (35.1%) CC eyes, while 238 (64.9%) eyes were recorded as CC without PCA. The percentages of PFV, PCD, and PLC were 10.9%, 26.7%, and 5.4% in CC eyes (n = 367), respectively. The most common concomitant of PFV eyes was PCD (42.5%), and PFV was the most frequent (17.3%) one in PCD eyes. PLC was only associated with PFV (15%) and PCD (50%). The occurrence rates of surgical complications ranged from 0 to 5.4%, and no statistical difference was found between the eyes with and without PCA (all P > 0.05).

Conclusions: PFV, PCD, and PLC play a very important role in the CCs. The effect of fetal vessels in PFV eyes might be an abnormally strong attachment on the posterior capsule, leading to PLC and PCD. Even in PCA patients, severe surgical complication can also be avoided with well-designed and skilled operation. This trial is registered with NCT03905044 at http://ClinicalTrials.gov.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2020 Xixia Ding et al.

Figures

Figure 1
Figure 1
Main operative steps for 3 types of posterior capsule abnormalities (PCAs) in congenital cataract (CC) eyes. (a–c) are for persistent fetal vasculature (PFV). (a) A preoperative view; (b) after the anterior capsulotomy and major cortex removing with vitrector, the fetal vessels (yellow arrows) and the central dense plaque opacity were present clearly; (c) it was left aphakia after lensectomy combined with posterior capsulotomy and anterior vitrectomy. (d–f) are for posterior capsule defect (PCD). (d) A preoperative view; (e) a large and irregular preexisting PCD (yellow arrows) was shown after anterior capsulotomy and central cortex removed with vitrector; (f) the irregular PCD was trimmed to be a round one and followed by the anterior vitrectomy without primary intraocular lens (IOL) implantation. (g–i) are for posterior lenticonus (PLC). (g) A preoperative view; (h) the huge PLC (yellow arrows) turned up after the anterior capsulotomy and cortex removed with vitrector; (i) a single-piece IOL was implanted in the capsule bag which was followed by the capsulotomy of PLC and anterior vitrectomy.
Figure 2
Figure 2
(a–c) Intraoperative views for 3 types of persistent fetal vasculature (PFV), including anterior (a), combined (b), and posterior (c) PFVs. Fetal vessels were visible on the photos. Yellow arrows point out the fetal vessels from anterior segments, while red arrows point out the vessels from the posterior segments. (d–f) Intraoperative appearances for 3 types of posterior capsule defect (PCD). Type I: a large defect with sinking cortex in the anterior vitreous; type II: a cluster of fine defects in the posterior capsule; type III: a defect with a concurrent persistent fetal vasculature (PFV). (g) Intraoperative sight for posterior lenticonus (PLC). The yellow arrow shows the involved areas of PLC.
Figure 3
Figure 3
Some ocular concomitant of persistent fetal vasculature (PFV) in congenital cataract (CC) eyes: (a) yellow arrows show persistent pupillary membrane (PPM); (b) iris coloboma (yellow arrows); (c) the prolonged ciliary processes (red arrows) are visible, and the exposed equator of lens is pointed out by the yellow arrow (lens dislocation); (d) the yellow arrow shows the umbilication of lens.
Figure 4
Figure 4
The ocular concomitant rates in congenital cataract (CC) eyes with posterior capsule abnormality (PCA), including persistent fetal vasculature (PFV), posterior capsule defect (PCD), and posterior lenticonus (PLC): (a) PFV is often associated with PCD, persistent pupillary membrane (PPM), iris coloboma, lens dislocation, PLC, uveitis, secondary glaucoma, prolonged ciliary processes, spherocrystal, morning glory syndrome, and umbilication of lens; (b) PCD is often combined with PFV, PPM, uveitis, PLC, morning glory syndrome, and lens dislocation; (c) PLC concomitant is PFV or PCD.
Figure 5
Figure 5
The comparison of surgical complication rates between the eyes with and without posterior capsule abnormality (PCA).

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