laser treatment method of secondary cataract with prevalent Elschnig pearls in children with pseudophakia after congenital cataract removal

BACKGROUND: Despite the advances of high-tech treatments, congenital cataract still accounts for up to 17.3% cases of blindness and low vision. Meanwhile, secondary cataract remains a leading cause of poor visual acuity after congenital cataract removal, especially in early childhood. AIM: To evaluate the efficacy of the developed method for laser treatment of secondary regenerative cataract with prevalent Elschnig pearls in children with pseudophakia after congenital cataract removal. METHODS: It was an interventional, single-center, prospective, single-arm study. A total of 115 children (130 eyes) diagnosed with secondary cataract underwent surgery with the proprietary YAG laser method. Massive conglomerates of Elschnig pearls prevailed in the cataract morphology. The laser treatment method was based on combination of focused and defocused Nd:YAG laser irradiation. Earlier, the children underwent phacoaspiration of congenital cataract followed by intraocular lens implantation. RESULTS: The children were aged 7 months to 14 years (mean: 65.2 ± 3.81 months). Full optic effect after YAG laser destruction was achieved in every case; both anterior and posterior surfaces of the intraocular lens were optically clean and free of signs of complications. In 3 months, the central optic zone was still fully clear in 96.1% cases. In 14.6%, Elschnig pearls recurred within 3 to 6 months was detected in 14.6% after 3 to 6 months and were successfully treated with the same laser technique. CONCLUSION: The proposed method of laser treatment of secondary cataract allows effective and minimally extensive removal of massive clusters of Elschnig pearls from the anterior and posterior surfaces of the intraocular lens, rendering fully clear optic zone in the pupillary area with minimal laser energy parameters. This method features several advantages, including the lack of need for open-globe surgery and thus prevention of intraocular complications, the opportunity for anesthesia-free procedure, significantly improved visual acuity, minimal effect on corneal astigmatism, and lower recurrence rates (14.6%).