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TA Albini, SC Yiu, JC Song; The Results of Primary Posterior Capsulotomy and Anterior Vitrectomy as Compared to Traditional Extracapsular Cataract Extraction with Intraocular Lens Implantation in Pediatric Patients . Invest. Ophthalmol. Vis. Sci. 2002;43(13):391.
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Purpose: Establishing a long-term clear visual axis is of great importance in the surgical management of cataracts in children who are at risk for amblyopia. Since children have a high rate of developing posterior capsular opacification (PCO), one approach to pediatric cataracts has been to perform a primary posterior capsulotomy (PPC) and anterior vitrectomy (AV) at the time of cataract extraction with intraocular lens implantation to preclude the possibility of PCO. However, PPC might increase the occurrence of cystoid macular edema (CME) or render intracapsular haptic fixation more difficult, increasing the likelihood of posterior chamber lens dislocation. The purpose of this study was to evaluate the safety and efficacy of cataract extraction with PPC and AV as compared to traditional cataract extraction with intraocular lens implantation in pediatric patients. Method: The study is a retrospective chart review of all 73 pediatric patients who underwent extracapsular cataract extraction with or without PPC and AV over the last 15 years at Children's Hospital of Los Angeles (CHLA). The study was approved by the Committee on Clinical Investigations at CHLA. Results: A preliminary review of the data collected so far reveals that 20 patients underwent cataract extraction without PPC and 22 patients underwent cataract extraction with PPC and AV. The groups were similar in their age, male to female ratios, percentage of traumatic cataracts, and initial visual acuities. The mean follow up was significantly longer in the group not undergoing PPC and AV since this is a more recently introduced procedure. There was no increased risk of intraoperative complications in patients undergoing PPC and AV as compared to patients undergoing cataract extraction without PCC. None of the patients had dislocated intraocular lenses or developed CME. 35% of patients not receiving a PPC and AV developed PCO. Preliminary review of the data suggested that children undergoing PPC and AV had better visual acuity at 6 weeks postoperatively and at their most recent follow up. Conclusion: In children undergoing cataract extraction with intraocular lens implantation, PPC and AV is safe and effective as compared to traditional cataract extraction without PPC and AV. In addition this procedure may allow for better postoperative visual acuity, optimizing management of pediatric cataracts.
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