Primary posterior capsulorhexis with and without anterior vitrectomy in congenital cataracts

PURPOSE: To determine whether anterior vitrectomy is necessary along with primary posterior capsulorhexis in children less than 5 years of age with congenital cataracts. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHOD: This prospective study comprised 18 eyes of 16 children whose mean age was 2.3 years (range 3 months to 5 years). Primary posterior continuous curvilinear capsulorhexis (PCCC) and posterior chamber intraocular lens (IOL) implantation were performed in all eyes. No vitrectomy was done in 8 eyes (Group 1); an anterior vitrectomy was performed in 10 eyes (Group 2). Optic capture through the posterior capsule was achieved in 3 eyes in Group 1 and in 5 eyes in Group 2. Average follow-up was 13.3 months. RESULTS: Five eyes (62.5%) in Group 1 needed secondary pars plana vitrectomy because the visual axis was obscured; no eye in Group 2 needed a secondary procedure. Four Group 1 eyes developed significant complications (updrawn pupil, decentration, occlusio pupillae, transient glaucoma). While no Group 2 eye developed a serious complication, some degree of pigment dispersion was noted in all the eyes. CONCLUSION: The results suggest that anterior vitrectomy is desirable along with primary PCCC in children younger than 5 years with congenital cataracts.