LAUSR

Summary One of the multiple challenges posed by pediatric cataract surgery relates to the special management of the posterior capsule (PC). The risk of PC opacification is much higher in children, nearing 100% in the course of a few months with the standard techniques and intraocular lenses (IOL), even with a thorough capsular bag polishing. As the performance of a Nd:YAG laser capsulotomy can be impractical in children, an intraoperative solution is advisable. This normally involves a posterior capsulorhexis, with or without anterior vitrectomy, and either with a standard IOL or a special design such as the bag-in-the-lens concept or using techniques as posterior capture of the optic. Pediatric cataracts frequently include special features as in opacities a the PC level, which can range from cellular to fibrotic, with different degrees in the maturity of fibrous membranes. In some cases as with posterior polar cataracts there may be an extreme weakness or absence of the central PC. Other situations may involve additional materials as in persistence of anterior hyperplastic primary vitreous. This presentation reviews the decision process, surgical options, and possible risks involved in dealing with the PC in pediatric cataract surgery.