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Brian M. Jerkins, Natalie C. Kerr, Mary Ellen Hoehn; Pediatric Pseudophakic Posterior Capsular Opacity. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6724. doi: https://doi.org/.
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Posterior Capsular Opacification (PCO) is the most common complication of extracapsular cataract extraction in the pediatric population. It increases the risk of amblyopia. Many options are available for the management of PCO including primary posterior capsulectomy with anterior vitrectomy, primary pars plana vitrectomy (PPV) with capsulotomy, IOL entrapment through a posterior capsulorhexis, and Neodymium:yttrium-aluminum-garnet (Nd:YAG). We propose that preservation of the posterior capsule at the time of cataract extraction and treatment of PCO with Nd:YAG provides an effective treatment option.
A 15-year retrospective chart review for extracapsular cataract extractions performed at the University of Tennessee. Data collected included initial management of the posterior capsule, age at time of cataract extraction, development of PCO significant enough for surgical intervention, elapsed time to first procedure to clear visual axis, number of procedures needed to clear the visual axis, and length of follow up. Inclusion criteria were ages 6 months to 7 years at the time of surgery, pseudophakia, preservation of the posterior capsule, no previous PPV, minimum 6 months postoperative follow up, and Acrysof intraocular lens implantation.
Sixty-one eyes of 43 patients were identified that met inclusion criteria with 21 eyes between 6 months and 3 years (younger group) and 40 eyes between 3 and 7 years of age (older group). A lower percentage of patients in the older group required a procedure to clear the visual axis compared to the younger group (69.23% to 95.23% p=0.04), and this result reached statistical significance. All (100%) patients had a clear visual axis at their last visit with average follow up of 4.12 (younger group) and 4.15 years (older group) and an average age at cataract extraction of 1.42 and 5.11 years, respectively. A significantly lower number of procedures were needed to maintain a clear visual axis in the older group compared to the younger group with a range of 1-3 procedures in both age groups (1.19 to 1.63 P=0.03). Patients in the older group were treated with Nd:YAG alone except for 1 patient who required a PPV to clear the visual axis after previous Nd:YAG. In the younger group, 14 patients were treated with Nd:YAG initially with 3 patients requiring a PPV as a second procedure and 6 received a PPV as the initial treatment. Although not statistically significant, there was also a trend for a longer elapsed time until the first procedure to clear the visual axis in the older group compared to younger group (22.59 to 12.74 months P=0.07).
Nd:YAG capsulotomy is a reasonable option for management of pediatric pseudophakic posterior capsular opacity in pediatric patients, especially in patients over 3 years of age.
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