Secondary cataracts in infants after lensectomies

Abstract

Three infants, one who was two weeks old, and two who were two months old, underwent lensectomy and vitrectomy in a total of four eyes for congenital cataracts by means of an automated suction cutter. Two patients with unilateral opacities underwent combined cataract extraction and epikeratophakia, and one with bilateral congenital cataracts underwent cataract extractions and was fit with extended wear contact lenses. In all cases, the surgery involved at least a 5-mm posterior capsulotomy with a shallow anterior vitrectomy, and was uneventful. Three of the four eyes developed new opacities that required surgical removal three to five months after the original surgery. Cytological evaluation of the specimen obtained from one patient showed this material to be lens epithelium. In all three cases, the material grew without the support of the posterior capsule; in one patient the material appeared to have seeded onto the iris. This previously unreported complication in infants with congenital cataracts who have undergone posterior capsulotomy and anterior vitrectomy emphasizes the need for frequent retinoscopies on such patients. The absence of the posterior capsule does not guarantee that these children will not develop secondary growth of lens epithelium which may obstruct the visual axis.