Management of pediatric traumatic cataract using a 23-gauge vitrectomy system

Objective To evaluate the safety and efficacy of a 23-gauge transconjunctival sutureless vitrectomy system for the management of traumatic cataract in children and to determine the short-term outcome and complications.Methods This retrospective study involved a consecutive series of 32 children (32 eyes) who suffered from traumatic cataract from March 2009 to September 2011.Each eye underwent anterior capsulotomy,lentectomy,posterior capsulotomy,and anterior vitrectomy through a superior limbal incision using a 23-gauge vitrectomy cutter.A limbal port incision was used to introduce an infusion micro cannula to maintain the anterior chamber with balance salt solution.The superior limbal incision was enlarged to 2.75 mm by a diamond knife.An intraocular lens (IOL) was implanted in the bag or sulcus.The enlarged incision was closed with one or two 10-0 nylon suture.Refraction correction with spectacles and amblyopic training began 1 week postoperatively.The mean follow-up period was 17.1±8.2 months.Results All the surgical procedures were successfully performed in all 32 eyes.No intraoperative complication was noted.The mean postoperative intraocular pressure (IOP) was 12.9±2.4 mmHg.Postoperative inflammation was mild.No fibrin reactions,vitreous escape or incarceration were noted in the anterior chamber.Neither significant aqueous flare nor aqueous cell was observed 1 week after surgery.Five eyes (15.6％) had mild posterior synechiae.All eyes had primary IOL implantation.IOL was implanted in the bag in 22 eyes (68.7％) and in the sulcus in 10 eyes (31.3％).The mean axial length of the 32 eyes was 22.36±1.03 mm at the time of operation and the mean IOL power was +22.97±1.89 D.Four eyes (12.5％) developed visual axis opacification (VAO) and required capsulotomy by YAG laser.IOL pigmentation was noted in 5 eyes (15.6％).No cases of ocular hypertension,glaucoma,choroidal detachment or retinal detachment were observed.The mean logMAR best corrected visual acuity (BCVA) was 2.37±1.16 preoperatively and 0.39±0.48 at the last follow-up,BCVA was significantly improved (t=10.916,P＜0.01).BCVA was improved in 29 eyes postoperatively.The predictors of good visual outcomes (BCVA≥20/40) included metal as the object causing injury,cataract operation within 3 month after injury and good amblyopic treatment (Fisher=O.028,0.047,0.000,respectively.P＜0.05).Conclusion Management of traumatic cataract in children via an anterior approach using the 23-gauge transconjunctival sutureless vitrectomy system appears safe and effective.Advantages include a more precise capsulotomy and more sufficient lensectomy and anterior vitrectomy,stable intraoperative IOP,and reduced surgical trauma and inflammation. Key words: Cataract,traumatic; Children; Vitrectomy,23-gauge; Early visual rehabilitation; Intraocular lens