Congenital cataract extraction with primary aphakia and secondary intraocular lens implantation in the ciliary sulcus

Purpose: To evaluate the results of cataract extraction without primary intraocular lens (IOL) implantation in children. Setting: Ophthalmology Unit, University Hospital, Strasbourg, France. Methods: This retrospective study comprised 157 congenital cataract cases (55 bilateral and 47 unilateral) treated between 1985 and 2001. Evaluated were the functional results (visual acuity, binocular vision) and factors influencing the prognosis (age at surgery, stage of cataract development, associated pathology, postoperative complications). In all patients, cataract extraction was via the pars plana and anterior vitrectomy was performed, leaving a peripheral capsular collarette in place. Postoperatively, all the patients were fitted with glasses or contact lenses, after which they had secondary implantation of an IOL in the ciliary sulcus. Results: The functional results were similar to those in the literature for eyes with or without an IOL. Nevertheless, the literature reports a 25 % risk for reoperation in the first 2 years after implantation and secondary vitrectomy for reopacification of the visual axis in 20 % of bilateral cases and 38 % of unilateral cases. Conclusions: Our functional results indicate that in cases of bilateral congenital cataracts, initial rehabilitation with aphakic correction and secondary IOL implantation leads to a predictable postoperative refraction and fewer complications. Visual rehabilitation in unilateral aphakia was more difficult because of poor compliance with contact lenses, generally leading to a preference for early IOL implantation.