Necessity of vitrectomy when optic capture is performed in children older than 5 years

To determine whether anterior vitrectomy is necessary when optic capture is performed in children between 5 and 12 years old with congenital cataract.

Iladevi Cataract and IOL Research Center, Ahmedabad, India.

This prospective randomized controlled study comprised 41 eyes of 25 children whose mean age was 83.57 months (range 60 to 144 months). Intraocular lens (IOL) implantation with optic capture through a primary posterior continuous curvilinear capsulorhexis was performed in all the eyes. The IOL haptics were bag fixated. Patients were randomly assigned to 1 of 2 groups. Vitrectomy was performed in 1 group (n = 21 eyes) and not performed in the other group (n = 20 eyes). The mean follow-up was 21.04 months. A Student t test and chi-square test were used for statistical analysis.

All eyes in the vitrectomy group and 30% in the no-vitrectomy group had a clear visual axis at the last follow-up (P <.001) The visual axis was obscured as a result of anterior vitreous fibrosis in 70% of eyes in the no-vitrectomy group. High-contrast visual acuity was not significantly different between groups (P =.28). Low-contrast sensitivity was significantly better in the vitrectomy group (P =.02). Eighteen eyes (85.7%) in the vitrectomy group and 16 eyes (80%) in the no-vitrectomy group developed deposits on the IOL (P =.62). The deposits were present at the last follow-up in 4 eyes (19.0%) in the vitrectomy group and in 6 eyes (30.0%) in the no-vitrectomy group (P =.85). Three eyes (14.3%) in the vitrectomy group and 8 eyes (40.0%) in the no-vitrectomy group developed synechias (P =.06).

The results suggest that anterior vitrectomy is necessary with optic capture in children with congenital cataract who are between 5 and 12 years old.