Comparison of different surgical approaches for pediatric cataracts: complications and rates of additional surgery during long-term follow-up

Abstract

OBJECTIVES: To compare long-term postoperative complications of pediatric cataract surgery with primary intraocular lens (IOL) implantation associated with posterior capsulotomy (PC) and anterior vitrectomy (AV) between patients treated with a corneal or pars plicata/pars plana approach. METHODS: Children who underwent cataract surgery with in-the-bag primary IOL implantation were divided into two groups according to PC and AV surgical approach: a corneal approach (group 1) and a pars plicata/pars plana approach (group 2). Only patients with a follow-up duration of more than two years were included. Long-term surgical outcomes were retrospectively reported. RESULTS: The mean follow-up period was 10.00±3.13 years. No cases of glaucoma or retinal detachment were reported. The mean age at surgery was 34.57±22.66 months. Forty-six children were included (27 eyes in group 1 and 29 eyes in group 2). The most frequent postoperative complication was corectopia, followed by visual axis opacification. Both complications occurred more frequently in group 1 ( p <0.001). After cataract surgery, the rate of additional surgeries in group 1 was 51.9%, while in group 2, the rate was 27.6% ( p =0.1132). CONCLUSION: The pars plicata/pars plana approach with PC and vitrectomy with primary in-the-bag IOL implantation for pediatric cataracts is a safe procedure.

Resultados a longo prazo de implante primário de lente intraocular no saco capsular em crianças menores que 24 meses

“…Although posterior capsulotomy and anterior vitrectomy were performed via the pars plana approach (12) with in-the-bag IOL implantation in all patients, almost 14% of the children developed VAO in this study. We noted that, over time, a large capsulotomy is required to reduce VAO.…”

“…Although advances in IOL designs and surgical techniques have led to lower rates of visual axis opacification (VAO), VAO continues to be frequently observed in children; its incidence is higher in children than adults (12) . At younger ages, the higher number of mitotically active cells results in faster growth of the residual lens epithelial cells remaining after surgery (6,(13)(14)(15) .…”

Surgical outcomes of primary intraocular lens implantation for the treatment of aphakia in pediatric cataracts in the Brazilian public health system

“…An incidence of 28% of corectopia was described in patients who underwent surgery before 7 months of age using different techniques (3) . Comparing the anterior and posterior approaches for capsulotomy and vitrectomy in pediatric cataracts with primary IOL implant, in patients aged 3 months to 9 years old, the authors found more complications in the anterior approach (9) . No corectopia or vitreous tag was detected as a postoperative complication in this study.…”

“…The IATS study reports 7% and 14% glaucoma or glaucoma suspect in the first and fifth follow-up year respectively, excluding patients with corneal diameter less than 10 mm in which the incidence of glaucoma is significantly higher, but including patients with persistent fetal vasculature (PFV). PFV presented a risk 3.1 higher than eyes without this condition in the first follow-up year (7)(8)(9)(10)(11)(12)(13)(14)(15) . In the IoLunder2 study, the incidence of glaucoma or persistent ocular hypertension was approximately 30%; however, in this study, one-third of the patients had some ocular anomaly, including corneal diameter less than 10 mm and PFV (16) .…”

Case Report: A Novel Mutation in the CRYGD Gene Causing Congenital Cataract Associated with Nystagmus in a Chinese Family

“…However, the visual outcome is largely dependent on the timing of surgery once a dense cataract occurs ( Lim et al, 2017 ). Most vision loss associated with congenital cataract is due to amblyopia ( Mansouri et al, 2013 ), and others are due to postoperative complications such as secondary glaucoma and retinal detachment either from birth or in early infancy ( Chak and Rahi, 2008 ; Koch et al, 2019 ; Wang et al, 2020 ). The pathogenesis of congenital cataract can be divided into genetic, environmental, and unknown causes.…”