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Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Outcomes of pediatric cataract surgery with triamcinolone-assisted vitrectomy
Tzu-Hsun Tsai1, Chia-Ying Tsai2, Jehn-Yu Huang3
1Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China.
Insights
Triamcinolone-assisted vitrectomy is safe for pediatric cataract surgery. Visual axis opacification (VAO) is uncommon, but more frequent in infants under 12 months.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital cataracts require surgical intervention in pediatric patients.
- Lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy are surgical techniques used for pediatric cataracts.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients who underwent lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy for congenital cataract.
Main Methods:
- Retrospective study of 34 pediatric patients (younger than 72 months) undergoing the specified surgical procedures.
- Inclusion of 51 eyes with congenital cataract, with or without intraocular lens (IOL) implantation.
- Data collected on surgical age, follow-up duration, IOL placement, pupil status, visual acuity, and visual axis opacification (VAO).
Main Results:
- The median visual acuity was 0.3 for unilateral and 0.1 for bilateral cataracts.
- A low incidence of visual axis opacification (VAO) was observed (5.9%), requiring further surgery in three eyes.
- Surgery within the first 12 months of life was significantly associated with the development of VAO (p=0.047), with an incidence of approximately 15.8% in this subgroup.
Conclusions:
- Triamcinolone-assisted vitrectomy is a viable option for pediatric cataract surgery with no serious long-term adverse effects.
- Visual axis opacification (VAO) is a potential complication, particularly in infants operated on before 12 months of age.
- The incidence of VAO, while low, suggests it may be an unavoidable complication in a subset of very young patients.
Background/Purpose:
To evaluate outcomes in pediatric patients undergoing lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy for congenital cataract.
Methods:
This retrospective study included 34 patients younger than 72 months who underwent lensectomy, posterior capsulotomy, and triamcinolone-assisted vitrectomy with or without intraocular lens (IOL) implantation for cataract at the National Taiwan University Hospital from July 2006 to December 2012.
Results:
Fifty-one eyes from 34 patients with cataract (unilateral in 17 patients, bilateral in 17 patients) were included. The mean age at surgery was 26.74 months (range: 2-72 months). The mean postoperative follow-up was 27.8 months (range: 6-72 months). Primary IOL implantation was performed in 25 eyes, 21 of which had the IOL implanted in the capsular bag. Fifty eyes had a central round pupil. The median logarithm of the minimum angle of resolution visual acuity was 0.3 in patients with unilateral cataract and 0.1 in those with bilateral cataract. Three eyes (5.9%) developed visual axis opacification (VAO) and required further surgery. Univariate analysis using Fisher's exact test indicated that surgery in the first 12 months of life was significantly associated with development of VAO (p=0.047). The incidence of postoperative VAO was approximately 15.8% in this age group.
Conclusion:
Triamcinolone-assisted vitrectomy can be used in pediatric cataract surgery without serious long-term adverse effects. While the incidence of VAO is low, it appears unavoidable in approximately one-sixth of patients who undergo surgery before 12 months of age.
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