Congenital cataracts successfully removed with 25-gauge vitrectomy tools

HONG KONG — Use of 25-gauge vitrectomy tools in pediatric patients was successful for removal of congenital cataracts, a surgeon said here.

"Our opinion is that the 25-gauge system confers several advantages. It's a very safe procedure, and it allows for precise control of surgery," Kevin YH Chee, MBBS, said. "Issues with instrumentation are not significant, and we feel this system really does make a huge difference."

Kevin YH Chee

The retrospective noncomparative case series looked at 20 eyes of 14 patients in whom surgery was performed at a mean age of 14 weeks.

"We did surgery as early as 10 days and as late as 48 weeks," Dr. Chee said.

Each of the patients underwent diagnostic screening to look for an underlying cause of the congenital cataract; 50% had no obvious cause.

The technique involved making two limbal side port incisions approximately 120° to 180° apart, Dr. Chee explained. He said these ports could be made with a trocar from the 25-gauge vitrectomy pack or a separate 0.6 mm knife.

Dr. Chee said the first 17 cases were performed with the trocar and 16 of these cases had wound leaks, but in the last three procedures, the surgeons used the knife and did not have any leakage.

The patients underwent anterior capsulotomy, lens aspiration, posterior capsulotomy and anterior vitrectomy and were left aphakic, he said. The wounds were hydrated and sutured. Postoperatively, all of the patients received treatment for amblyopia, Dr. Chee said.

"Of our 20 cases, we were able to successfully complete the surgery in 95% of patients," he said. One case had a fibrous anterior capsule that required the surgeon to switch to a 20-gauge system, Dr. Chee explained.

There were no intraoperative complications, and mean follow-up was approximately 18 months, in which no major complications occurred except one eye developed ocular hypertension, he said.