Secondary Intraocular Lens Placement

Abstract

The Infant Aphakia Treatment Study (IATS) has shown that cataract surgery in infants with primary intraocular lens (IOL) implantation has more complications with no added visual benefit (Lambert et al., JAMA Ophthalmol 132(6):676–682, 2014; Plager et al., Ophthalmology, Elsevier Inc. 118:2330–2334, 2011). Therefore, most surgeons perform lensectomy, posterior capsulotomy, and anterior vitrectomy in infants up to 7 months of age and contact lenses or glasses are used for visual rehabilitation. The peripheral capsular bag is preserved in the anticipation of these children undergoing secondary IOL implantation when older (Kim et al., Acta Ophthalmol 90: 231–236, 2012; Speeg-Schatz et al, J Cataract Refract Surg 31:750–756, 2005). The natural healing response in children is for the capsular bag to fuse and lens epithelial cells to proliferate inside the bag with the formation of a Soemmering ring. The technique for implanting an IOL secondarily in children is discussed in detail in this chapter. A step-by-step guide to visualizing and opening the Soemmering ring, aspiration of proliferating lens matter, and IOL implantation with optic capture is demonstrated.