Posterior capsulotomy technique may help maintain clear visual field after congenital cataract surgery

Can J Ophthalmol. 2009;44(4):441-443.

Posterior vitrectomy using 25-gauge instrumentation after congenital cataract surgery may aid in preventing secondary opacification.

"Secondary visual axis opacification remains a major disabling complication of pediatric cataract surgery. Leaving the posterior capsule intact may induce it," according to a study. "We introduced a 25-gauge pars plana casulovitrectomy to reduce the complications of previous primary posterior capsulotomy and anterior vitrectomy."

The study, which reviewed nine eyes of five patients operated on using the 25-gauge technique and a single, sutureless pars plana approach, noted a clear visual axis in eight eyes after 4 years. One eye required Nd:YAG capsulotomy 7 months after the initial surgery to enlarge the opening of the capsulectomy.

For the surgery, cataracts were removed with phacoemulsification through a 3.5 mm scleral tunnel, and a foldable IOL was placed in an in-the-bag position. During the same surgical session, a 25-gauge probe was placed through a trocar cannula that was placed 3 mm posterior to the limbus before cataract removal.

The posterior capsule and anterior hyaloid were removed. This is important, the study authors noted, because the hyaloid face may act as a nidus for abnormal growth of epithelial cells, which may result in a dense opacification of the surface and disturb the visual axis.