1. Surgical Techniques and Postoperative
Complications in Pediatric Cataract Surgery
Wan -Soo Kim, MD., PhD.
Kyung-Won Suk, MD.
Jung-Hyo Ahn , MD.
Department of Ophthalmology
Maryknoll Hospital & Pusan National Univ.
Busan, Korea
Poster
2007 ASCRS San Diego

2. Poster
2007 ASCRS San Diego
Purpose
 To evaluate postoperative complicaitions
of different surgical techniques in pediatric
cataract.

3. Poster
2007 ASCRS San Diego
Methods
• Maryknoll Hospital
• 4 surgeons
• Retrospective review: 210 eyes of 144 children
• January 1994 ~ June 2005
• Three groups according to the surgical techniques used
(1) group I (n=78) : IOLs in the bag +intact posterior capsule
(2) group 2 (n=48) : IOLs in the bag
+ posterior continuous curvilinear capsulorhexis(PCCC)
+ anterior vitrectomy;
(3) group 3 (n=84) : IOLs in the bag + PCCC + optic capture.
• Postoperative posterior capsular opacity(PCO), secondary intervention for
PCO, strabismus, inflammation, glaucoma, vitreoretinal complications were
evaluated.

4. Poster
2007 ASCRS San Diego
Table 1. Dermographics of patients having pediatric cataract surgery
Group 1 Group 2 Group 3
No. of eyes (%) 78 (37.1) 48 (22.9) 84 (40.0)
Age at surgery (years) 11.15±5.06 3.13±2.74 6.97±4.31
Implanted IOLs ＊
heparin-surface
modified PMMA† 32 22 4
Acrylic 46 26 80
Follow - up period (years) 7.2±5.23 3.8±1.21 2.2±1.15
*
IOL: Intraocular lens.
†
PMMA: Polymethyl methacrylate.

5. Poster
2007 ASCRS San Diego
Results
• Different from those in the past, current
surgical methods for pediatric cataract
entail either the optic capture of IOL or
anterior vitrectomy through PCCC.
• PCO is the most frequent postoperative
complication.

6. Poster
2007 ASCRS San Diego
Results
# PCO
: 70 eyes (87.1%) in group 1
: 4 eyes(8.3%) in group 2
: No eyes in group 3
• Ten eyes (33.3%) had recurrence of PCO
when PCO was treated by Nd:YAG laser
posterior capsulotomy.
• None had PCO recurrence with secondary
optic capture of IOL.

7. Poster
2007 ASCRS San Diego
Results
• Postoperative inflammation and IOL
decentration were more common in group
2 than in the other groups.
• There was no statistically significant
diffenence in the prevalence of
postoperative glaucoma between the
groups.
• Neither vitreoretinal complication nor
infection was found in our series.

8. Poster
2007 ASCRS San Diego
Table 2. Postoperative inflammation
Complications
No. of eyes (%)
Complications
Group 1 Group 2 Group 3
Updrawn pupil 2(2.2) 2(4.1) 0
Posterior synechiae 6(7.1) 6(12.5) 0
Pigment depositioin on
IOL ＊
4(4.7) 4(8.3) 0
IOL decentration 4(4.7) 4(8.3) 0
＊
IOL: Intraocular lens.

9. Poster
2007 ASCRS San Diego
Table 3. Postoperative glaucoma and vitreoretinal complications
Complications
No. of Eyes (%)
Complications
Group 1 Group 2 Group 3
Glaucoma 4(4.7) 4(8.3) 2(2.3)
Cystoid macular
edema
0 0 0
Infection
/Endophthalmitis
0 0 0
Retinal detachment 0 0 0

10. Poster
2007 ASCRS San Diego
Discussions
 Hutcheson and coauthors report anterior hyaloid face
opacification after pediatric Nd:YAG laser capsulotomy
in 57% of cases requiring a second treatment.
J AAPOS 1999
Atkinson and Hiles favor Nd: YAG capsulotomy 3 weeks
after initial cataract surgery. However , many
complications can arise including IOL damage, raised
intraocular pressure, and retinal problem.
Am J Ophthalmol
1994

11. Poster
2007 ASCRS San Diego
Discussion
Anterior vitrectomy may be associated with vitreous
incarceration in the wound and vitreous adhesion that
increase the risk of retinal detachment.
Finally, after primary posterior capsulectomy with
vitrectomy, many children’s visual axis become reoccluded
by secondary membrane necessitating repeated
capsulotomies and sometimes pars plana membranectomy.
Howard V.Gimbel J Cataract Refract Surg 1997

12. Poster
2007 ASCRS San Diego
Conclusions
Consequently, it is believed that IOL optic capture
during pediatric cataract surgery prevents the
movement of lens epithelial cells to the rear due to
the firm adhesion between the anterior and
posterior lens capsules, which minimizes the onset
of PCO, decreases the need for secondary laser
and surgical treatment, and maintain the visual
axis essential for development of children’s visual
acuity.