Five-Year Postoperative Outcomes of Bilateral Aphakia and Pseudophakia in Children up to 2 Years of Age: A Randomized Clinical Trial.

PURPOSE: Comparative evaluation of complications and visual outcomes following bilateral congenital cataract surgery in children up to 2 years of age with and without primary intraocular lens (IOL) implantation at 5 years follow-up. DESIGN: Randomized controlled clinical trial. METHODS: Sixty children (120 eyes) up to 2 years of age undergoing bilateral congenital cataract surgery were randomized to Group 1, primary aphakia (n = 30), or Group 2, primary IOL implantation (pseudophakia) (n = 30). A single surgeon performed surgeries with identical surgical technique. All patients were followed up regularly until 5 years postoperatively. At each follow-up, glaucoma, visual axis obscuration (VAO) requiring surgery, and inflammation (cell deposits, posterior synechiae) were assessed. Visual acuity was assessed until 5 years follow-up. The first operated eye was selected for statistical analysis. RESULTS: Median age of the patients at time of surgery was 5.11 months (aphakia group) and 6.01 months (pseudophakia group) (P = .56). Five years postoperatively, incidence of glaucoma was 16% and 13.8% in Groups 1 and 2 (P = .82). Incidence of posterior synechiae was significantly higher in the pseudophakia group (27.6%) compared to the aphakia group (8%) (P = .004). VAO requiring surgery was seen in 8% and 10.3% of eyes in Groups 1 and 2 (P = .76). Mean logMAR visual acuity at 5 years follow-up was 0.59 ± 0.33 and 0.5 ± 0.23 in Groups 1 and 2, respectively (P = .79). However, more eyes in the pseudophakic group started giving documentable vision earlier in their postoperative follow-ups. CONCLUSIONS: Incidence of postoperative complications was comparable between the groups, except for a higher incidence of posterior synechiae in pseudophakic eyes. Visual rehabilitation was faster in the pseudophakic group.

Postoperative outcomes of intraocular lens implantation in the bag versus posterior optic capture in pediatric cataract surgery.

PURPOSE: To compare complications in children up to 4 years old having cataract surgery with intraocular lens (IOL) implantation using 2 techniques: in-the-bag IOL with anterior vitrectomy or optic capture of IOL with no anterior vitrectomy. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective randomized control clinical trial. METHODS: The study included children having cataract surgery with IOL implantation. Patients were randomized to Group 1 (in-the-bag 3-piece hydrophobic acrylic IOL [Acrysof MA60AC] with anterior vitrectomy) or Group 2 (optic capture of the same IOL without anterior vitrectomy). Intraoperative complications were documented. Postoperative visual axis obscuration (VAO), glaucoma, cell deposits on the IOL, and posterior synechiae were compared at 1, 3, 6, and 12 months. RESULTS: The study comprised 61 children (61 eyes). The mean ages were 14.8 months ±11.47 (SD) in Group 1 (n = 30) and 18.2 ± 11.47 months in Group 2 (n = 31). Overall, only 1 eye in Group 1 developed a VAO requiring membranectomy 4 months postoperatively, and 2 eyes in Group 1 developed glaucoma over 12 months (P = .49). Intraocular lens cell deposits and posterior synechiae were comparable between groups. The IOL could not be captured in 5 eyes (16.1%); no complications occurred in these eyes. CONCLUSIONS: Optic capture of 3-piece hydrophobic acrylic IOLs could be achieved in most eyes. The VAO, glaucoma, and inflammation were comparable 12 months postoperatively. Thus, optic capture of an IOL is an alternative surgical technique that can be used to avoid vitrectomy, even in children younger than 4 years.

Long-term postoperative outcomes after bilateral congenital cataract surgery in eyes with microphthalmos.

PURPOSE: To evaluate the long-term impact of bilateral cataract surgery on postoperative complications, influence of age at surgery on the pattern of axial growth and central corneal thickness (CCT), and visual and orthoptic assessment in microphthalmic eyes. SETTING: Iladevi Cataract and IOL Research Centre, Ahmedabad, India. DESIGN: Prospective longitudinal study. METHODS: This study assessed children with microphthalmos who had bilateral congenital cataract surgery. Microphthalmos was defined as an eye that has an axial length (AL) that was 2 standard deviations smaller than what is normally expected at that age. All eyes were left aphakic. One of the 2 eyes was randomly selected for analysis. Postoperative complications, AL, CCT, and visual acuity were documented. RESULTS: This study included 72 eys of 36 children. The mean age of the patients was 4.8 months ± 6.2 (SD) (range 0.5 to 15 months). Postoperative complications included secondary glaucoma (11/36, 30.6%), visual axis obscuration (4/36, 11.1%), and posterior synechiae (10/36, 27.8%). A significant rate of change was observed in axial growth up to 4 years and in CCT up to 3 years postoperatively. When age at the time of surgery was correlated with the profile of the rate of change in AL and CCT at 1 month and 1, 2, and 4 years, statistically significant differences in AL and CCT at all timepoints were found. Loss of vision after surgery occurred in 2 eyes. CONCLUSION: After early surgical intervention, an acceptable rate of serious postoperative complications and good visual outcomes were obtained in microphthalmic eyes. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Long-term longitudinal assessment of postoperative outcomes after congenital cataract surgery in children with congenital rubella syndrome.

PURPOSE: To assess the intraoperative and long-term longitudinal postoperative outcomes of cataract surgery in children with congenital rubella syndrome. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective observational clinical study. METHODS: Children with congenital rubella syndrome who had cataract surgery were enrolled. All microphthalmic eyes were left aphakic. A 1-piece hydrophobic acrylic intraocular lens was implanted in the capsular bag in eyes without microphthalmos. The postoperative observations included complications and visual assessments up to 5 years. RESULTS: The mean age of the 21 children (37 eyes) was 3.97 months ± 2.1 (SD). Intraocular lens implantation was performed in 12 eyes (32.4%), while 25 eyes (67.6%) were left aphakic. Postoperatively, the median follow-up was 60.79 months. Posterior synechiae were observed in 22 eyes (59.5%) and visual axis opacification in 9 eyes (24.3%). Secondary glaucoma was observed in 16 eyes (43.2%), of which 14 were aphakic and 1 was pseudophakic. Nine eyes required trabeculectomy. Age at surgery and ocular comorbidities were statistically significantly associated with secondary glaucoma (P<.05, χ(2) test and Kendall τB criteria P<.05). The mean corrected distance visual acuity at the final follow-up was 0.72 ± 0.56 logMAR. CONCLUSIONS: The long-term results suggest good visual outcomes can be obtained with congenital cataract associated with congenital rubella syndrome after early surgical intervention. The rate of serious postoperative complications was acceptable.

Contrast sensitivity assessment in pediatric cataract surgery: comparison of preoperative and early postoperative outcomes.

PURPOSE: To evaluate the preoperative and early postoperative differences in contrast sensitivity at high and low spatial frequencies after cataract extraction with in-the-bag intraocular lens (IOL) implantation in children presenting with lamellar and posterior subcapsular cataract. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective clinical trial. METHODS: In eyes with lamellar or posterior subcapsular cataract having cataract surgery with Acrysof SN60WF IOL implantation, contrast sensitivity testing was performed using the CSV-1000E sine wave grating test face at 3, 6, 12, and 18 cycles per degree under photopic (85.0 candelas [cd]/m(2)) and mesopic (2.7 cd/m(2)) conditions. The main outcome measures were contrast sensitivity under photopic and mesopic conditions preoperatively and 1 and 3 months postoperatively. The corrected distance visual acuity (CDVA) was recorded in logMAR units. The effect of the type of cataract and of age at surgery on contrast sensitivity preoperatively and 1 and 3 months postoperatively was also evaluated. RESULTS: The mean age of 13 patients (22 eyes) was 7.85 years ± 2.6 (SD). There was a statistically significant difference in contrast sensitivity at every timepoint at every spatial frequency under mesopic and photopic conditions. There was also a statistically significant improvement in CDVA from preoperatively to 1 month postoperatively and from 1 month to 3 months postoperatively (both P<.001). CONCLUSION: There was a significant improvement in contrast sensitivity at high and low spatial frequencies, even in children older than 4 years, after cataract surgery for lamellar or posterior subcapsular cataract. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Assessment of peripapillary retinal nerve fiber layer thickness using scanning laser polarimetry (GDx VCC) in normal Indian children.

PURPOSE: To obtain reference values of RNFL thickness in normal Indian children and to study the association of RNFL thickness with central corneal thickness(CCT) and axial length(AL). MATERIALS AND METHODS: 200 normal Indian children (mean age 8.6 ± 2.9 yrs) were examined on the GDxVCC. The inferior average (IA), superior average (SA), temporal-superior-nasal-inferior-temporal (TSNIT) average and nerve fiber index (NFI) values were recorded and compared between males and females as well as between the different age groups. The association of TSNIT average with AL and CCT was examined. RESULTS: Values for the RNFL parameters were-SA: 64.9 ± 9.7, IA: 63.8 ± 8.8, TSNIT average: 53.5 ± 7.7 and NFI 21.5 ± 10.8. Superior, inferior and TSNIT averages did not differ significantly between males and females (P = 0.25, P = 0.19, P = 0.06 respectively; Mann-Whitney U test). No significant differences were found in TSNIT average across age groups. There was a statistically significant positive correlation between CCT and TSNIT average (r = 0.25, r 2 = 0.06, P < 0.001). The correlation TSNIT average and AL(r = -0.12; r2 = 0.01) was not significant (P = 0.2). CONCLUSION: Reference values for RNFL parameters reported for Indian children are similar those reported in adults. There is a small correlation between central corneal thickness and RNFL as reflected in average TSNIT.

Subtle signs of an intact anterior vitreous face during pediatric cataract surgery.

We describe the subtle signs of the anterior vitreous face as a bulging structure, a homogenous staining pattern of 3 buttonholes, and a lamellar or fibrillar pattern intact. This should help surgeons correctly recognize the intact anterior vitreous face.

Anti-inflammatory effect of low-molecular-weight heparin in pediatric cataract surgery: a randomized clinical trial.

PURPOSE: To determine if intraocular infusion of low-molecular-weight heparin (enoxaparin) reduces postoperative inflammation in pediatric eyes undergoing cataract surgery with IOL implantation. DESIGN: Prospective masked randomized controlled trial. METHODS: setting: Private, institutional practice. study population: Twenty children (40 eyes) undergoing bilateral cataract surgery with IOL implantation were randomized to receive enoxaparin in the intraocular infusion fluid (BSS) (Group I) or not to receive enoxaparin (Group II). The first eye was randomly assigned to 1 of the 2 groups and the second eye received alternate treatment. observation procedure: Patients were followed up in the first week and 1 and 3 months after surgery. main outcome measures: Anterior chamber flare and cells (Hogan's criteria), cell deposits on IOL, posterior synechiae. RESULTS: One week postoperatively, no eyes had >grade 2 flare/cells. Proportion of eyes with grade 2 cells was higher in eyes that did not receive enoxaparin (Group II: 80% vs Group I: 40%, P = .009). In the first week >10 small cell deposits were noted in the eyes that received enoxaparin (Group I: 20%, Group II: none, P = .005). Large cell deposits first appeared at 1 month in 40% of eyes in Group I and 55% of eyes in Group II (P = .34) and increased at 3 months (60% in both groups, P > .999). Posterior synechiae were seen in 10% of eyes in Group I at 1 month, which persisted at 3 months; no eyes in Group II showed posterior synechiae (P = .14). CONCLUSION: The results of our study suggest that there does not seem to be a benefit of using enoxaparin in the infusion fluid with respect to early postoperative inflammation.

Corneal endothelial morphologic assessment in pediatric cataract surgery with intraocular lens implantation: a comparison of preoperative and early postoperative specular microscopy.

PURPOSE: To observe longitudinal changes in the corneal endothelium after pediatric cataract surgery with intraocular lens implantation. DESIGN: Prospective, longitudinal study. METHODS: settings: Iladevi Cataract and IOL Research Centre, Ahmedabad, India. study population: This study included 100 pediatric eyes undergoing cataract surgery with intraocular lens implantation. Posterior capsule management was based on the status of the posterior capsule. Two-port anterior limbal vitrectomy was carried out after posterior capsule plaque peeling. observation procedures: Corneal endothelial morphologic features: endothelial cell density (cell/mm(2)), coefficient of variation, percentage of hexagonality, and central corneal thickness were assessed. main outcome measures: To evaluate whether there is a difference in endothelial cell morphologic features before surgery and 3 months after surgery and also whether pediatric cataract surgery with and without anterior vitrectomy has any impact on the endothelial cell morphologic features. RESULTS: A comparison of preoperative and postoperative specular microscopy is given here: endothelial cell density, 3225.1 ± 346.8 cells/mm(2) versus 3057.7 ± 330.1 cells/mm(2) (P < .001); coefficient of variation, 27.5 ± 10.6 versus 37.7 ± 16.3 (P < .001); percentage of hexagonality, 58.1 ± 15.3 versus 48.6 ± 13.4 (P < .001); and central corneal thickness, 529 ± 30 µm versus 527 ± 34 µm (P = .64). There was 5.1% decrease in mean endothelial cell loss at 3 months after surgery. No statistically significant difference was noted in the percentage decrease in mean endothelial cell density between eyes undergoing cataract surgery with intact posterior capsules, eyes undergoing manual posterior capsulorrhexis without anterior limbal vitrectomy, and eyes undergoing anterior limbal vitrectomy (P = .543). CONCLUSIONS: Endothelial cell loss with currently practiced techniques of pediatric cataract surgery is within acceptable limits by adhering to the principles of close chamber technique.

Outcomes of pediatric cataract surgery in anterior persistent fetal vasculature.

PURPOSE: To report the intraoperative performance and postoperative outcomes in eyes with anterior persistent fetal vasculature (PFV). SETTING: Iladevi Cataract & IOL Research Centre, India, and Filatov Institute Odessa, Ukraine. DESIGN: Prospective interventional case series. METHODS: Eyes with anterior PFV had surgery using a standardized surgical technique. Plaque peeling was used for small plaques and partial excision for larger plaques. In eyes in which the entire lens converted into a fibrovascular tissue, extensive capsulectomy with anterior 2-port limbal vitrectomy was performed. Microphthalmic eyes had no intraocular lens implantation. RESULTS: This study comprised 33 eyes. The mean age at surgery was 6.30 months ± 5.16 (SD). Microcornea was observed in 10 eyes (30.3%). Within the morphology of cataract, 10 eyes (30.3%) had the lens converted into fibrovascular mass, of which 4 had associated prominent ciliary process. Anterior continuous curvilinear capsulorhexis (CCC) and manual posterior CCC were performed in 23 eyes (69.7%) and 3 eyes (9.1%), respectively. Intraoperatively, posterior capsule plaque was seen in 20 eyes (60.6%). In 31 eyes (93.9%), 2-port limbal anterior vitrectomy was performed and in 2 eyes (6.1%), pars plana vitrectomy was performed. Intraocular lens implantation was performed in 16 eyes (48.5%); 17 eyes (51.5%) were left aphakic. Visual axis obscuration was observed in 6 eyes (18.2%). At the 3-year follow-up, visual acuity remained stable in 11 eyes (33.3%) and improved in 22 eyes (66.6%). CONCLUSION: The results suggest that good visual outcomes can be obtained in PFV eyes after surgical intervention, with an acceptable rate of serious postoperative complications. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Pars plicata posterior continuous curvilinear capsulorhexis.

We describe a technique of pars plicata manual posterior capsulorhexis performed after implantation of an intraocular lens (IOL) in pediatric cataract surgery. The technique can be used to create a posterior capsulectomy of a desirable size in a controlled manner to avoid destabilization of the IOL. It can be applied selectively in cases of pediatric cataract surgery.

Visual axis opacification after cataract surgery and hydrophobic acrylic intraocular lens implantation in the first year of life.

PURPOSE: To report the incidence of visual axis opacification (VAO) requiring surgery after cataract extraction with hydrophobic acrylic intraocular lens (IOL) implantation during the first year of life. SETTING: Storm Eye Institute, Charleston, South Carolina, USA; Iladevi Cataract and IOL Research Center, Ahmedabad, India. DESIGN: Cohort study. METHODS: Medical records of patients younger than 1 year who had primary posterior capsulectomy, vitrectomy, and in-the-bag hydrophobic acrylic IOL implantation were reviewed. In bilateral cases, 1 eye was randomly chosen. The need for surgery for visually significant VAO was evaluated 12 months after cataract surgery. RESULTS: Seventy-two eyes were included. The mean age at cataract surgery was 6.0 months. Seventeen eyes (23.6%) required surgery for VAO a mean of 6.2 ± 2.9 months postoperatively. The odds for VAO surgery were 3.5 times greater in eyes of female children than in eyes of male children. For AcrySof MA60AC, SA60AT, SN60AT, or SN60WF IOLs, surgery for VAO was required in 25%, 23%, 23%, and 23% of eyes, respectively. The earliest time between cataract and secondary VAO surgery was relatively later (9.0 months) with the SN60WF IOL than with the MA60AC, SA60AT, or SN60AT IOL (4.4, 2.2, and 2.0 months, respectively). CONCLUSIONS: Nearly 25% of operated eyes of infants required a secondary surgical procedure for VAO; the rate was higher in eyes of female infants but did not differ between IOL models. The data indicate that surgery for VAO is required later in eyes with an SN60WF IOL than in eyes in which other AcrySof IOLs were used. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Posterior capsule management in congenital cataract surgery.

UNLABELLED: Management of the posterior capsule significantly affects the outcome of pediatric cataract surgery. Posterior capsule opacification (PCO) is rapid and virtually inevitable in very young children when adult-style cataract surgery is performed and the posterior capsule is left intact. In eyes with pediatric cataract, primary posterior capsulotomy and vitrectomy are considered routine surgical steps, especially in younger children. The site of intraocular lens (IOL) fixation and the surgical technique used also affect the prevalence of PCO. The present systematic review evaluates the options available to prevent PCO or ensure a clear central visual axis after pediatric cataract surgery. Newer approaches to posterior capsule management such as pars plicata posterior capsulorhexis, sutureless vitrectomy, sealed-capsule irrigation, and bag-in-the-lens IOL are discussed. Management of the posterior capsule in the presence of a preexisting posterior capsule defect and posterior capsule plaque and options to treat PCO are also reviewed. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Incidence, management, and postoperative outcomes in pediatric eyes with coexisting posterior capsule plaque and cataract.

PURPOSE: To determine the incidence and evaluate the management and postoperative outcomes of posterior capsule plaque in pediatric eyes with cataract. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Cohort study. METHODS: This study evaluated consecutive eyes of children aged 1 month to 15 years having cataract surgery. In cases of posterior capsule plaque, plaque peeling (smaller plaque) or posterior vitrectorhexis (larger plaque) was performed. Intraocular lenses (IOLs) were implanted in all except microphthalmic eyes. The postoperative observations included visual axis obscuration and IOL decentration. RESULTS: Posterior capsule plaque was observed in 90 (13.4%) of 670 eyes (63 [13.2%] of 475 children). Of eyes with posterior capsule plaque, 70 had total white mature cataract and 20 had posterior subcapsular cataract. Plaque peeling was performed in 41 eyes (45.5%) and partial excision of the plaque with a vitrectome in 49 eyes (54.4%). The mean follow-up was 24.03 months ± 2.68 (SD). Of the 60 eyes that had an IOL, 54 (90%) had in-the-bag implantation and 6 (10%) had ciliary sulcus implantation. Postoperatively, there was no IOL decentration. Visual axis obscuration developed in 6 eyes (6.7%). CONCLUSIONS: Posterior capsule plaque was frequently observed in pediatric cataractous eyes, especially in eyes with total cataract. After plaque peeling or plaque removal with a vitrectome, the IOL was stable in the capsular bag and the visual axis was clear.

Outcomes of cataract surgery and intraocular lens implantation with and without intracameral triamcinolone in pediatric eyes.

PURPOSE: To evaluate whether intracameral triamcinolone has an effect on anterior segment inflammation and visual axis obscuration after pediatric cataract surgery with intraocular (IOL) implantation. SETTING: Iladevi Cataract and IOL Research Institute, Ahmedabad, India. METHODS: This retrospective age-matched case-control study comprised consecutive eyes of children having phacoaspiration, posterior capsulectomy, vitrectomy, and IOL implantation. In the study group, eyes received a standardized application of an intracameral preservative-free triamcinolone acetonide suspension intraoperatively. In the control group, age-matched consecutive eyes had surgery with a similar technique but without intracameral preservative-free triamcinolone acetonide. Cell deposits, posterior synechias, visual axis obscuration, and intraocular pressure (IOP) were evaluated 1 month and 12 months postoperatively. RESULTS: The mean patient age at surgery was 9.15 months +/- 5.04 (SD) in the study group (41 eyes) and 9.34 +/- 5.10 months in the control group (83 eyes) (P = .91). The visual axis was not obscured in any eye in the study group, while 9 eyes (10.8%) in the control group had an obscured axis; the difference between groups was statistically significant (P<.029). Six eyes (7.2%) in the control group required secondary membranectomy with pars plana vitrectomy. There was a statistically significant difference between the 2 groups in posterior synechias and cell deposits (both P<.033) and no significant difference in preoperative or postoperative IOP (P = .29 and P = .50, respectively). CONCLUSION: Pediatric eyes receiving intracameral triamcinolone intraoperatively had significantly less anterior segment inflammation and no visual axis obscuration after cataract surgery with IOL implantation.

Triamcinolone-assisted vitrectomy in pediatric cataract surgery: intraoperative effectiveness and postoperative outcome.

PURPOSE: To evaluate intraoperative effectiveness and postoperative outcome of intracameral, preservative-free triamcinolone acetonide in pediatric cataract surgery. METHODS: A prospective, interventional, observational case series was performed in children undergoing congenital cataract surgery. Three standardized applications of triamcinolone acetonide were used. Postoperatively, IOP, pachymetry, glaucoma, posterior synechiae, cell deposits, and posterior capsule opacification were studied at 1 week, 1 month, and 12 months after surgery. RESULTS: Mean age at the time of surgery was 14.8 +/- 12.2 months. Of 43 eyes, 5 were kept aphakic and 38 received IOL implantation. After manual posterior continuous curvilinear capsulorhexis and the first injection of triamcinolone, the anterior vitreous face disturbance was visualized as free-floating vitreous strands going into the incision in 18.6% of eyes (8 of 43). Triamcinolone was injected a second time after anterior vitrectomy: residual vitreous strands were identified and removed in 7 of these 8 eyes. Triamcinolone was used for a third time after IOL implantation: residual vitreous strands were identified in 5.3% of eyes (2 of 38). Mean IOP was 12.2 +/- 2.2 mm Hg preoperatively and was 13.6 +/- 3.2 at the 1 week follow-up visit, 12.8 +/- 2.8 at 1 month, and 12.4 +/- 2.0 mm Hg at 12 months. CONCLUSIONS: Preservative-free triamcinolone acetonide improved visualization of the vitreous during pediatric cataract surgery, thereby ensuring thorough and complete anterior vitrectomy. IOP was not affected, and no adverse postoperative results were observed.

Intraoperative posterior capsule flutter in posterior lentiglobus.

Posterior capsules of pediatric eyes with lens disorders have complex morphological variations with differing etiologies and visual prognoses. We describe a unique case of intraoperative posterior capsule flutter in an eye of a child undergoing cataract surgery, which we interpret as a possible expression of posterior lentiglobus.

Intraoperative performance and postoperative outcomes of cataract surgery in infant eyes with microphthalmos.

PURPOSE: To report the intraoperative performance and postoperative outcomes in microphthalmic eyes of infants younger than 1 year having bilateral cataract surgery. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: This prospective observational study excluded eyes with ocular trauma, inflammation, posterior persistent fetal vasculature causing stretching of the ciliary processes or tractional retinal detachment, aniridia, or chorioretinal coloboma. Intraoperative observations included the rate of peripheral extension of the anterior capsule tear, intraoperative iris prolapse/trauma, and posterior capsule tear. All eyes were left aphakic. Postoperative observations included visual outcome, posterior synechias, visual axis obscuration (VAO), and glaucoma. RESULTS: The study evaluated 42 eyes of 21 infants. The mean age at surgery was 4.0 months +/- 2.6 (SD) and the mean follow-up, 25.6 +/-11.3 months. Surgery was performed using the limbal approach in 30 eyes (71.4%) and by pars plicata lensectomy in 12 eyes (28.6%). In the limbal group, 3 eyes (10.0%) had an incomplete anterior capsulorhexis, 2 eyes (6.7%) had iris trauma, and 2 eyes (6.7%) had peripheral extension of the posterior capsulectomy edge. At the final follow-up, visual acuity remained stable in 4 eyes (9.5%) and was improved in 38 eyes (90.5%). The complications were posterior synechias in 15 eyes (35.7%), glaucoma in 13 eyes (30.9%), and VAO in 7 eyes (16.7%). CONCLUSION: The results suggest that good visual outcomes can be obtained in microphthalmic patients with bilateral congenital cataract after early surgical intervention, with an acceptable rate of serious postoperative complications.

Triamcinolone-assisted vitrectomy in pediatric cataract surgery.

We describe a technique to manage anterior vitreous face disturbance that may occur during performance of a manual posterior continuous curvilinear capsulorhexis (PCCC) in pediatric eyes. The technique renders the vitreous visible to the anterior segment surgeon and ensures a thorough and complete anterior vitrectomy in congenital cataract surgery after a manual PCCC using preservative-free triamcinolone acetonide.