ARTICLE Influence of the vitreolenticular interface in pediatric cataract surgery Jan Van Looveren, MD, FEBO, Arnout Vael, MD, Nick Ideler, MD, Hedwig Sillen, MD, Danny Mathysen, PhD, Marie-Jos  e Tassignon, MD, PhD, FEBO Purpose: To report the status of Berger space in pediatric cata- ract cases and the influence of anterior vitreolenticular interface dysgenesis during primary posterior continuous curvilinear capsu- lorhexis (PCCC). Setting: Department of Ophthalmology, Antwerp University Hos- pital, Edegem, Belgium. Design: Prospective case series. Methods: The study comprised consecutive pediatric cataract cases planned for bag-in-the-lens intraocular lens (BIL IOL) implantation. A video-based analysis of the surgical interventions included the type of crystalline lens opacification, presence of a posterior capsule plaque (PCP), presence of anterior vitreolenticular interface dysgenesis, complications during primary PCCC, integrity of the anterior hyaloid membrane, need for anterior vitrectomy, and feasibility of BIL IOL implantation. Results: Abnormalities in Berger space were observed in 35 of the 64 pediatric cataract cases. Anterior vitreolenticular interface dysgenesis was most often found in cases with persistent fetal vasculature (PFV) and those with posterior cataract. Anterior vitre- olenticular interface dysgenesis was diagnosed significantly more often in eyes with unilateral cataract and those with PCP. In pediat- ric cataract cases presenting with PCP and anterior vitreolenticular interface dysgenesis, the primary PCCC procedure was surgically more demanding, often resulting in detectable breaks in the anterior hyaloid membrane (58.6%) and sometimes necessitating an un- planned anterior vitrectomy (13.8%). Bag-in-the-lens IOL implantation was feasible in all except 1 eye with PFV, which was left aphakic. Conclusions: Primary vitreolenticular interface abnormalities are often encountered during pediatric cataract surgeries, especially when confronted with PCP in a unilateral cataract. The presence of anterior vitreolenticular interface dysgenesis may complicate a primary PCCC procedure, resulting in an unplanned anterior vitrec- tomy in some cases. J Cataract Refract Surg 2018; -:-–- Q 2018 Published by Elsevier Inc. on behalf of ASCRS and ESCRS T he presence of a retrolenticular space between the posterior crystalline lens capsule and the anterior hyaloid membrane was first described by the anat- omist Emil Berger in 1887 in a postmortem specimen. 1 In 1985, Weidle 2 showed the presence of this Berger space in the living human eye by filling it with an ophthalmic viscosurgical device (OVD). Recently Berger space was visualized intraoperatively during adult cata- ract surgery using real-time optical coherence tomogra- phy (OCT). 3 In normal developing eyes, Berger space is fully formed by the ninth month of gestation. 4 Although there is improving knowledge on the anatomy and bio- metric parameters in pediatric cataract eyes, 5 there is lit- tle information on the vitreolenticular interface in these cases. In such eyes, persistent fetal vasculature (PFV) membrane–like structures between the posterior lens capsule and the retrolenticular fibrovascular plaque have been described in literature. 6 M€ ullner-Eidenb€ ock et al. 7 hy- pothesized all congenital unilateral cataract presenting with posterior capsule plaque (PCP) to be a consequence of a localized developmental anomaly with insufficient regres- sion of the fetal vasculature. If that is the case, one might expect to be confronted with a high rate of anterior vitreo- lenticular interface dysgenesis. During the primary posterior continuous curvilinear cap- sulorhexis (PCCC) procedure, Berger space can be injected with an OVD to facilitate posterior capsule excision and to protect the anterior hyaloid membrane from injury. 2 The anterior vitreous membrane is kept intact if possible Submitted: February 4, 2018 | Final revision submitted: June 15, 2018 | Accepted: June 28, 2018 From the Department of Ophthalmology (Van Looveren, Vael, Mathysen, Tassignon), Antwerp University Hospital, Edegem; and the Faculty of Medicine and Health Sciences (Van Looveren, Vael, Ideler, Sillen, Mathysen, Tassignon), University of Antwerp, Antwerp, Belgium. Drs. Van Looveren, Vael, and Ideler contributed equally to this work. Corresponding author: Jan Van Looveren, MD, FEBO, Department of Ophthalmology, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium. Email: jvanlooveren@hotmail.com. Q 2018 Published by Elsevier Inc. on behalf of ASCRS and ESCRS. 0886-3350/$ - see frontmatter https://doi.org/10.1016/j.jcrs.2018.06.052 1