[Congenital cataract with pre-existing posterior capsule defect]

To evaluate the diagnostic signs, intraoperative complications and postoperative outcomes in children with congenital cataract and pre-existing posterior capsule defect [PPCD]. This interventional case series was conducted on 14 eyes of 7 patients who underwent lensectomy-anterior vitrectomy for congenital cataract with PPCD. All children had bilateral cataract. Preoperative diagnostic sign of PPCD detected under maximum pupil dilation in patients without a mature cataract included a well-demarcated horizontal oval defect with white margin and scattered white dots around the defect. The greatest lens opacity was over the defect itself. In patients with mature cataract, PPCD was diagnosed during operation. Bimanual irrigation/aspiration and 2-port anterior vitrectomy was performed in all cases. The patients included in 2 girls and 5 boys with mean age of 11.4 +/- 4.1 month. PPCD was diagnosed preoperatively in 5 patients [10 eyes] and intraoperatinely in 2 patients [4 eyes]. Intraocular lens was implanted in 2 eyes of one patient and 12 eyes were left aphakic. Except for nucleus dislocation into the anterior vitreous in our first case which was successfully removed, no other intraoperative complication occurred. During a mean follow up of 21.1 +/- 7.1 month [18-36 month] the visual axis remained clear in all the eyes. Establishing the diagnosis of PPCD preoperatively with fully dilated pupil and careful surgical planning prevents intraoperative complications and produces satisfactory technical results

[Prediction of visual outcome after penetrating keratoplasty for pseudophakic and aphakic corneal edema]

To evaluate the ability to predict visual outcome after penetrating keratoplasty [PKP] in patients with pseudophakic or aphakic corneal edema [PCE or ACE]. Medical records of 34 patients [34 eyes] who underwent PKP for PCE or ACE during 1994-2004 in Ahvaz were retrospectively analyzed for variables in the history and ocular examination before PKP and visual outcome after PKP. The predictive value of each preoperative variable including age, gender, method of intraocular lens [IOL] implantation, vitreous loss during cataract surgery, time between cataract and PKP surgery, and history of glaucoma or increased intraocular pressure [IOP] before PKP surgery on post-PKP visual outcome was assessed using logistic regression analysis. Odds ratio [OR] with 95% confidence interval [95% CI] was calculated for predictive factors. Mean follow-up was 23.6 months. Best corrected visual acuity [BCVA] of 20/200 or better was achieved in 17 patients [50%]. The strongest predictors of this outcome were time between cataract surgery and PKP [P=0.008, OR=3.50, 95% CI; 0.48-31.18], aphakia [P=0.027, OR=4.29, 95% CI; 0.36-114.8] and no history of glaucoma or increased IOP before PKP [P=0.020, OR=3.75, 95% CI; 0.71-21.41]. In patients with PCE and ACE who are candidates for PKP, time between cataract and PKP less than 20 month, no history of glaucoma or increased IOP before PKP, aphakia versus presence of IOL are associated with a better visual outcome