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Role of Primary Posterior Capsulorhexis and Anterior Vitrectomy In Pediatric Cataract Surgery

Autrata R., Rehurek J.,
Department of Ophthalmology, University Hospital Brno (Brno)

Purpose: To evaluate and determine the role of primary posterior capsulorhexis combined with primary anterior vitrectomy in the cataract extraction with or without posterior chamber intraocular lens implantation in children with congenital cataract.
Method: Prospective study evaluated 68 eyes of 45 children with unilateral or bilateral , total or partial congenital cataract, who underwent cataract extraction in the period of years 1992 - 1997. The mean age of children was 2,18 years (range 4months to 6 years) at the time of surgery. Primary posterior continuous curvilinear capsulorhexis (PCCC) was performed in all eyes. No anterior vitrectomy (AV) was done in 27 eyes (Group 1), and vitrectomy was performed in 41 eyes (Group 2). Posterior chamber intraocular lens (IOL) in the bag implantation was performed in39 eyes of children older than 1 year of age. The mean follow up was 6,8 years (range5 to 10 years). Visual outcome, complication rate (secondary cataract formation) were compared in both group of children.
Results: The mean best corrected visual acuity(BCVA) was 0,46 ± 0,32 in Group 1 and 0,69 ± 0,27 in Group 2 (p< 0.05) at last examination. Secondary procedure for obscured visual axis was done in 61 % eyes in Group 1 compared to 13% eyes in Group 2. Other complications rate (occurence of decentration, occlusio pupillae, decentration, transient glaucoma) was in 29% eyes of Group 1 versus 15% eyes of Group 2. No serious complication such as retinal detachment was found in vitrectomy eyes of Group 2. There was found significant better visual outcome and lower incidence of secondary procedures for visual axis opacities and of other complications in anterior vitrectomy eyes.
Conclusions: The results showed that primary anterior vitrectomy with primary posterior continuous curvilinear capsulorhexis is safe and more effective procedure than PCCC without vitrectomy in children younger than 6 years with congenital cataracts.