Cataract extraction and intraocular lens implantation with anterior vitrectomy in children

Extracapsular cataract extraction (ECCE) with selective intraocular lens (IOL) implantation has been the choice of the treatment for children with cataracts. With regard to surgical technique, ECCE with anterior segment vitrectomy has shown some success in reducing complications. Formation of a secondary membrane and opacity of the posterior capsule, however, are still major postoperative complications. To reduce these complications, we modified current surgical procedures with minimal incisions and manipulations.

ECCE with anterior segment vitrectomy was performed using Storz Protage's system in 84 eyes of 58 children ranging in age from 14 months to 14 years. Of 70 eyes of children aged above 3 years, IOLs were implanted simultaneously. Vision improvement and incidence of postoperative complications were compared with other standard procedures to determine the benefits of the operation for children with cataracts. After the anterior capsule was opened by continuous circular capsulorhexis or envelope-form capsulectomy, the lens cortex was excised. Subsequently, the IOL was implanted into the bag.

Nine-30 months follow-up showed that all of the central area of the posterior capsule remained clear except one eye in which a secondary membrane was partially formed on the anterior surface of vitreous. No other operative or postoperative complications occurred.

The results indicate that the modified procedure is beneficial in the prevention of secondary cataract formation and other postoperative complications in a short term follow-up, however, a long-term follow-up is warranted to evaluate its role in pediatric cataract surgery.