In-the-bag intraocular lens placement via secondary capsulorhexis with radiofrequency diathermy in pediatric aphakic eyes

Lixia Luo; Haotian Lin; Weirong Chen; Chunxiao Wang; Xinyu Zhang; Xiangchen Tang; Jianping Liu; Nathan Congdon; Jingjing Chen; Zhuoling Lin; Yizhi Liu

doi:10.1371/journal.pone.0062381

In-the-bag intraocular lens placement via secondary capsulorhexis with radiofrequency diathermy in pediatric aphakic eyes

PLoS One. 2013 Apr 24;8(4):e62381. doi: 10.1371/journal.pone.0062381. Print 2013.

Authors

Lixia Luo¹, Haotian Lin, Weirong Chen, Chunxiao Wang, Xinyu Zhang, Xiangchen Tang, Jianping Liu, Nathan Congdon, Jingjing Chen, Zhuoling Lin, Yizhi Liu

Affiliation

¹ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Abstract

Pediatric ophthalmologists increasingly recognize that the ideal site for intraocular lens (IOL) implantation is in the bag for aphakic eyes, but it is always very difficult via conventional technique. We conducted a prospective case series study to investigate the success rate and clinical outcomes of capsular bag reestablishment and in-the-bag IOL implantation via secondary capsulorhexis with radiofrequency diathermy (RFD) in pediatric aphakic eyes, in which twenty-two consecutive aphakic pediatric patients (43 aphakic eyes) enrolled in the Childhood Cataract Program of the Chinese Ministry of Health were included. The included children underwent either our novel technique for secondary IOL implantation (with RFD) or the conventional technique (with a bent needle or forceps), depending on the type of preoperative proliferative capsular bag present. In total, secondary capsulorhexis with RFD was successfully applied in 32 eyes (32/43, 74.4%, age 5.6±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved in 30 eyes (30/43, 70.0%), but in the remaining 2 eyes (2/32, 6.2%) the IOLs were implanted in the sulcus with a capsular bag that was too small. Secondary capsulorhexis with conventional technique was applied in the other 11 eyes (11/43, 25.6%, age 6.9±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved only in 3 eyes(3/43, 7.0%), and the IOLs were implanted in the sulcus in the remaining 8 eyes. A doughnut-like proliferative capsular bag with an extensive Soemmering ring (32/43, 74.4%) was the main success factor for secondary capsulorhexis with RFD, and a sufficient capsular bag size (33/43, 76.7%) was an additional factor in successful in-the-bag IOL implantation. In conclusion, RFD secondary capsulorhexis technique has 70% success rate in the capsular bag reestablishment and in-the-bag IOL implantation in pediatric aphakic eyes, particularly effective in cases with a doughnut-like, extensively proliferative Soemmering ring.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aphakia, Postcataract / pathology
Aphakia, Postcataract / surgery*
Capsulorhexis* / methods
Child
Child, Preschool
Diathermy* / methods
Female
Humans
Lens Implantation, Intraocular* / methods
Male

Grants and funding

This study was funded by the Key Projects for Hospital Clinical Disciplines of the Ministry of Health of China in 2010–2012 (Project No.175 in Document 439 of the Planning and Finance Secretary of Ministry of Health). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.