Removal of Posterior Capsule and Anterior Vitreous Using 25 Gauge Pars Plana Vitrectomy Combined With Phacoemulsification and In–The Bag Intraocular Lens Implantation in Cases of Pediatric Cataract

Abstract

Abstract: : Purpose: A major problem in pediatric cataract surgery is high incidence of visual axis opacification. To prevent visual axis opacification, we removed posterior capsule and anterior vitreous using 25 gauge (25G) vitrectomy with par plana approach at the time of cataract surgery in children. Methods: 25G pars plana capsulovitrectomy was performed on 6 eyes of 3 children by single surgeon. After dissection of limbal conjunctiva, one cannula was inserted with 25G trocar through sclera 3.0mm from the limbus and cannula was temporarily closed with a plug. And then cataract surgery with in–the–bag intraocular lens(IOL) implantation using slceral incision was performed. All eyes were implanted with 3–piece AcrySof(Alcon, Fort Worth, TX) which has a 6.0 mm optic diameter and 12.5 mm overall diameter. After IOL implantation and closing of scleral incision with 10–0 vicryl suture, balanced salt solution was infused through side port at limbus with 23–gauge tipped cannula and 25G vitrectomy probe was introduced through preplaced cannula. Removal of posterior capsule and anterior hyaloid membrane to create an opening of posterior capsule 4mm in diameter was performed with 25G vitrectomy probe. Then 25G cannula was removed and conjunctiva was closed with 10–0 vicryl suture. Results: The intraoperative and postoperative course was uneventful. The mean age of the patient was 4.5 years and the mean follow–up period was 6 months. None of vitreous escape was found during procedure and mean time for posterior capsulotomy was less than 5 minutes per eye. None of intraoperative complications occurred. Mean preoperative best–corrected visual acuity was 0.1 and mean best visual acuity at 6 months after surgery, 0.5. In all cases, opening of visual axis was maintained for 6 months. Minimal postoperative inflammation was seen in all eyes. None of complications related with surgery was found except contracture of posterior capsular opening in one eye. Conclusions: We successfully prevented visual axis opacification by removing posterior capsule and anterior vitreous using 25G vitrectomy systems at the time of cataract surgery in children. It is safer and time–saving technique to prevent visual axis opacification after pediatric cataract surgery.

Keywords: posterior capsular opacification (PCO) • cataract • vitreoretinal surgery