Surgical Techniques and Postoperative Complications in Pediatric Cataract Surgery

Wan -Soo Kim, MD., PhD.Kyung-Won Suk, MD.Jung-Hyo Ahn , MD.

Department of OphthalmologyMaryknoll Hospital & Pusan National Univ.

Busan, Korea

Poster2007 ASCRS San Diego

Poster2007 ASCRS San Diego

Purpose

To evaluate postoperative complicaitions of different surgical techniques in pediatric cataract.

Poster2007 ASCRS San Diego

Methods

• Maryknoll Hospital• 4 surgeons• Retrospective review: 210 eyes of 144 children• January 1994 ~ June 2005• Three groups according to the surgical techniques used (1) group I (n=78) : IOLs in the bag +intact posterior capsule (2) group 2 (n=48) : IOLs in the bag + posterior continuous curvilinear capsulorhexis(PCCC) + anterior vitrectomy; (3) group 3 (n=84) : IOLs in the bag + PCCC + optic capture.

• Postoperative posterior capsular opacity(PCO), secondary intervention for PCO, strabismus, inflammation, glaucoma, vitreoretinal complications were evaluated.

Poster2007 ASCRS San Diego

Table 1. Dermographics of patients having pediatric cataract surgery

Group 1 Group 2 Group 3

No. of eyes (%) 78 (37.1) 48 (22.9) 84 (40.0)

Age at surgery (years) 11.15±5.06 3.13±2.74 6.97±4.31

Implanted IOLs ＊

heparin-surfacemodified PMMA† 32 22 4

Acrylic 46 26 80

Follow - up period (years) 7.2±5.23 3.8±1.21 2.2±1.15

*IOL: Intraocular lens. †PMMA: Polymethyl methacrylate.

Poster2007 ASCRS San Diego

Results

• Different from those in the past, current surgical methods for pediatric cataract entail either the optic capture of IOL or anterior vitrectomy through PCCC.

• PCO is the most frequent postoperative complication.

Poster2007 ASCRS San Diego

Results

# PCO : 70 eyes (87.1%) in group 1 : 4 eyes(8.3%) in group 2 : No eyes in group 3

• Ten eyes (33.3%) had recurrence of PCO when PCO was treated by Nd:YAG laser posterior capsulotomy.

• None had PCO recurrence with secondary optic capture of IOL.

Poster2007 ASCRS San Diego

Results

• Postoperative inflammation and IOL decentration were more common in group 2 than in the other groups.

• There was no statistically significant diffenence in the prevalence of postoperative glaucoma between the groups.

• Neither vitreoretinal complication nor infection was found in our series.

Poster2007 ASCRS San Diego

Table 2. Postoperative inflammation

Complications

No. of eyes (%)Complications

Group 1 Group 2 Group 3

Updrawn pupil 2(2.2) 2(4.1) 0

Posterior synechiae 6(7.1) 6(12.5) 0

Pigment depositioin on IOL ＊ 4(4.7) 4(8.3) 0

IOL decentration 4(4.7) 4(8.3) 0

＊ IOL: Intraocular lens.

Poster2007 ASCRS San Diego

Table 3. Postoperative glaucoma and vitreoretinal complications

Complications

No. of Eyes (%)Complications

Group 1 Group 2 Group 3

Glaucoma 4(4.7) 4(8.3) 2(2.3)

Cystoid macular edema

0 0 0

Infection/Endophthalmitis

0 0 0

Retinal detachment 0 0 0

Poster2007 ASCRS San Diego

Discussions Hutcheson and coauthors report anterior hyaloid face op

acification after pediatric Nd:YAG laser capsulotomy in 57% of cases requiring a second treatment.

J AAPOS 1999

Atkinson and Hiles favor Nd: YAG capsulotomy 3 weeks after initial cataract surgery. However , many complications can arise including IOL damage, raised intraocular pressure, and retinal problem.

Am J Ophthalmol 199

4

Poster2007 ASCRS San Diego

DiscussionAnterior vitrectomy may be associated with vitreous incar

ceration in the wound and vitreous adhesion that increase the risk of retinal detachment.

Finally, after primary posterior capsulectomy with vitrectomy, many children’s visual axis become reoccluded by secondary membrane necessitating repeated capsulotomies and sometimes pars plana membranectomy.

Howard V.Gimbel J Cataract Refract Surg 1997

Poster2007 ASCRS San Diego

Conclusions

Consequently, it is believed that IOL optic capture during pediatric cataract surgery prevents the movement of lens epithelial cells to the rear due to the firm adhesion between the anterior and posterior lens capsules, which minimizes the onset of PCO, decreases the need for secondary laser and surgical treatment, and maintain the visual axis essential for development of children’s visual acuity.