We read the interesting article by Kohen et al., which supports the use of posterior optic capture without the need for anterior vitrectomy.1 There are very few large series that have described this technique previously in a prospective manner.2,3
The authors state that it was a prospective randomized study, but in the methods, they mention that the charts were reviewed and evaluated retrospectively. As a prospective study, it would be interesting to know how many children were excluded in either group because of inability to achieve the desired result, which could be because of intraoperative complications or postoperative problems.
It would be worthwhile to know a comparison in bilateral cases in this series if they were randomized to one of the techniques. This is more important when grading the inflammation after each technique. The follow-up after 2 years of age was after a long gap of 3 years. The age range of children was wide, from 2 years to 12 years. Were any modifications performed during a posterior rhexis in a toddler vs a 12-year-old boy as the capsular morphology would differ in them? The posterior capsule opacification rate is less as the age group is older than 2 years. Would you recommend doing a primary posterior capsulotomy in the older children, especially those older than 8 years as has been shown in this study? Were the two groups age matched? It would be interesting to know the technique for intraocular lens (IOL) explantation if required later for an unexpected myopic shift. The authors have used a single-piece heparin-surface-modified poly(methyl methacrylate) IOL, which is probably not manufactured now. We would like to emphasize that the currently available single-piece hydrophobic acrylic IOL is not an ideal IOL if this technique is planned because of the broad optic–haptic junction. The thinner the junction, the better the apposition of the capsules and fewer the chances of epithelial cells sequestering out of the bag. With a 3-piece IOL, we have shown good results even in difficult cases of pediatric cataract.4 In addition, the less rigid the optic, the more is the ease of a successful capture. The rest of the design that is important in preventing posterior capsule opacification when implanted in the bag is not much of a concern in posterior optic capture.
1. Kohen T, Davidova P, Lambert M, Wenner Y, Zubcov AA. Posterior continuous curvilinear capsulorhexis with anterior vitrectomy versus optic capture buttonholing without anterior vitrectomy in pediatric cataract surgery. J Cataract Refractive Surg 2021. doi: 10.1097/j.jcrs.0000000000000846
2. Kaur S, Sukhija J, Ram J. Comparison of posterior optic capture of intraocular lens without vitrectomy vs endocapsular implantation with anterior vitrectomy in congenital cataract surgery: a randomized prospective study. Ind J Ophthalmol 2020;68:84–88
3. Vasavada AR, Vasavada V, Shah SK, Trivedi RH, Vasavada VA, Vasavada SA, Srivastava S, Sudhalkar A. Postoperative outcomes of intraocular lens implantation in the bag versus posterior optic capture in pediatric cataract surgery. J Cataract Refract Surg 2017;43:1177–1183
4. Sukhija J, Kaur S, Korla S. Posterior optic capture of intraocular lens in difficult cases of pediatric cataract. Ind J Ophthalmol 2022;70:293–295