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D. J. Covert, D. P. Han, M. S. Ruttum; Pars Plicata Lensectomy and Vitrectomy for Congenital Cataracts. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6063.
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To assess the the anatomic outcomes, functional outcomes, intraoperative complications and postoperative complications associated with pars plicata lensectomy and vitrectomy (PPL/PPV) for congenital cataracts.
A retrospective record review was performed. Patients less than two years of age undergoing PPL/PPV between 10/92 and 12/07 by a single surgeon (DPH) were eligible. Patients whose cataracts were associated with persistent fetal vasculature or retinopathy of prematurity were excluded. Central capsulectomy with preservation of a capsular rim of approximately 3 mm was adopted uniformly in the latter part of the study.
Sixty-seven eyes of 40 patients were included; there were 24 boys and 16 girls. The average age at the time of surgery was 3.2 months (m) (standard deviation [SD]: 4.0 m, range: 7 days to 19 m). There were no intraoperative complications. The average follow up was 42.3 m (SD: 40.9 m, range: 6 weeks to 15 years). Aphakic rehabilitation consisted of spectacle correction in 41.2% of patients, contact lenses in 50.0%, secondary posterior chamber intraocular lens implantation in 2.9%, and a combination of spectacles and contact lenses in 5.9%. Of patients old enough to perform Snellen visual acuity testing, the average best-corrected visual acuity at last follow up period was 20/142 (range 20/20 to 1/400); patients undergoing bilateral surgery averaged 20/96 compared to patients with unilateral cataracts undergoing unilateral surgery who averaged 20/600 (p=0.01). Eight eyes (12%) experienced pupillary membranes and/or capsular opacification that required membranectomy to clear the visual axis; five of these were relieved with one surgery, two required two procedures, and one required three procedures. The average time elapsed from lensectomy to membranectomy was 71.6 days (SD: 38.0 days; range: 21 days to 154 days). Within the observed follow up period, the following ocular comorbidities were observed: aphakic open angle glaucoma in nine eyes (13.4% of eyes) of six patients (15.0% of patients); manifest strabismus in 19 patients (47.5% of patients); and nystagmus in six patients (15.0% of patients). Two eyes (3.0% of eyes) had slight peaking of the pupil. No retinal detachments or cases of endophthalmitis were observed.
PPL/PPV offers an alternative approach for the management of congenital cataract. Although no intraoperative complications were observed, postoperative capsular opacification and membrane formation, open angle glaucoma, nystagmus, strabismus, and amblyopia management pose significant postoperative challenges. Patients rendered bilaterally aphakic demonstrated better postoperative acuities than those with unilateral aphakia.
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