ATARACT Pediatric Cataract
Comparing Two Novel Approaches
to Cure Cataract in Children by Konstantin Yakimchuk
C
ongenital cataract usually manifests through lens opacification in early childhood. Although the etiology of cataract in many cases is still unknown, mutations in genes regulating lens morphology cause up to 30% of congenital cataracts.1 In infants, surgical treatment is highly recommended for dense cataracts, unilateral cataracts with strabismus, or bilateral cataracts with nystagmus. Currently, both capsulotomy and anterior vitrectomy for treatment of the congenital cataract can be performed either via limbus or pars plana.
A Tale of Two Innovative Approaches Two approaches for cataract surgery – corneal and pars plana/pars plicata – have been compared by Koch et al. in a study published in the recent issue of Clinics.2 The authors compared long-term complications of primary intraocular lens implantation caused by either a corneal or pars plicata or pars plana method. Earlier studies have shown that treatment of infantile congenital cataract with pars plana without intraocular lens (IOL) implantation provides more efficient lensectomy and vitrectomy and reduces local inflammation.3 Koch and co-authors have reported that all patients were operated for cataract using IOL implantation combined with posterior capsulotomy and anterior vitrectomy. The surgery commenced with a corneal incision followed by the injection of an ophthalmic viscosurgical device (OVD) into the anterior chamber, anterior capsulotomy, and lens removal. After this common part of the surgery, two distinct surgical techniques were carried out. According to the study, one group of patients underwent
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the surgery via the corneal approach, while the pars plana approach was used in another group.
Are These Surgical Approaches Completely Safe?
How do These Techniques Differ From Each Other?
Despite the recent advancements in cataract surgical cure, surgeons are still facing complications in their pediatric patients, such as visual axis opacification and inflammation. Although surgeons believe that the corneal technique is the easiest surgery to perform, the authors advocate the pars plicata/pars plana method due to both short- and long-term positive outcomes. Moreover, corectopia and visual axis opacification, rather severe complications, were observed only in patients who underwent the corneal type of surgery, while the pars plicata/pars plana technique did not show any side effects. As an explanation, the authors suggested that the corneal technique causes higher vitreous pressure. The present study was in line with a previous observation by Liu et al., who compared the efficiency of the limbal and pars plana approaches.4 Even though both surgical approaches were accompanied by several intraoperative complications in the iris, such as
Briefly, for the corneal approach, surgeons performed capsulotomy using capsulorhesis forceps, and inserted an infusion cannula to sustain electrolyte balance and a vitrectomer to accomplish anterior vitrectomy. Following IOL implantation, 10-0 nylon suture was applied. In contrast to corneal method, the pars plicata/pars plana technique implies an additional corneal incision in order to insert a cannula for balancing salt solution in the anterior chamber. After the aspiration of OVD, the corneal incision was sealed with nylon sutures and vessel coagulation followed. Finally, posterior capsulotomy and anterior vitrectomy were done. Polyglactin suture was applied to close the sclerotomy region. Another advantage of the study was that the authors used the longest follow-up period to compare the two surgical approaches. Notably, no incidence of glaucoma or retinal detachment have been detected. Although ophthalmologists regard the corneal method as the simplest technique, Koch et al. believe that the pars plana method will gain further popularity in the near future. The authors emphasize that the pars plana technique using a 20-gauge vitrector can be considered as a cautious and effective approach to implantation of intraocular lens with capsulotomy and vitrectomy.
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December/January 2020
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