Preoperative considerations and outcomes of primary intraocular lens implantation in children with posterior polar and posterior lentiglobus cataract.

PURPOSE: To report outcomes for pediatric posterior polar and posterior lentiglobus (lenticonus) cataracts.

METHODS: All posterior polar and posterior lentiglobus cataracts operated by the senior author were identified by retrospective database review. Excluding one eye in bilateral cases, preoperative and intraoperative details were collected. All eyes were analyzed for preoperative biometry and surgical details; however, a minimum of 4 weeks of follow-up was required for analysis of visual function.

RESULTS: Of 415 nontraumatic cataract cases with primary intraocular lens (IOL) implantation, 62 (15.0%) were identified with posterior polar (30/415, 7.3%) or posterior lentiglobus cataract (32/415, 7.7%). Twenty-eight (93%) posterior polar and all 32 posterior lentiglobus cases were monocular. Statistical comparison between the posterior polar and posterior lentiglobus groups for each of the following: age at time of surgery, preoperative axial length, lens thickness, and keratometry, showed no significant differences. IOL implantation was primarily in the capsular bag in both groups, 27/28 (96%) posterior polar and 25/32 (78%) posterior lentiglobus. Operative complications were rare. Twenty-five eyes in each group have follow-up greater than 4 weeks and were analyzed for visual function. A robust majority of patients in both groups, 21/25 (84%) posterior polar and 17/25 (68%) posterior lentiglobus cases, demonstrated postoperative visual acuity of 20/40 or better (or none to only a slight contralateral eye preference). Strabismus was infrequent in both groups pre- and postoperatively.

CONCLUSIONS: Posterior polar and posterior lentiglobus cataracts represent a large subset of nontraumatic cataracts in a pediatric cataract specialty practice. Visual outcomes are generally good. Complications are rare.