Posterior capsule opacification in children: comparison of posterior continuous curvilinear capsulorhexis alone and pars plana posterior capsulectomy with anterior vitrectomy.

PURPOSE: To compare the incidence, timing, and visual outcomes of posterior capsule opacification (PCO) following pediatric cataract surgery comprising either posterior continuous curvilinear capsulorhexis without anterior vitrectomy (PCCC-) or pars plana posterior capsulectomy with anterior vitrectomy (PPPC+).

METHODS

The medical records of pediatric patients undergoing surgery for congenital cataract at a single tertiary care facility from January 2013 to December 2022 were reviewed retrospectively. All eyes underwent primary intraocular lens implantation at the time of cataract surgery. A total of 643 eyes underwent PCCC- and 628 underwent PPPC+. Outcomes included PCO incidence, age at diagnosis, time to development, and best-corrected visual acuity (BCVA).

RESULTS

PCO incidence was significantly higher in the PCCC- group than in the PPPC+ group (144 [22.4%] vs 62 [9.9%] P < 0.001). Patients who developed PCO underwent initial cataract surgery at a mean age of 2.73 ± 2.04 years in the PCCC- group and 2.03 ± 1.63 years the PPPC+ group (P = 0.02). Age at PCO diagnosis was 3.87 ± 1.92 years in the PCCC- group and 5.28 ± 2.83 years in the PPPC+ group (P = 0.001). Time to PCO development was 1.84 ± 1.13 years in the PCCC- group and 2.56 ± 1.56 years in the PPPC+ group (P = 0.003). Of the 206 patients who developed PCO, 121 patients (58.7%) were cooperative for optotype testing. Preoperative BCVA was similar between groups (1.72 ± 0.59 and 1.68 ± 0.46 logMAR for PPPC- and PCCC+, resp. [P = 0.865]); postoperative BCVA improved significantly within each group (P < 0.001), with no intergroup difference (0.88 ± 0.40 and 0.93 ± 0.46 logMAR for PPPC- and PCCC+, resp. [P = 0.612]). The other 85 noncooperative children (41.3%) showed postoperative improvement in ability to fix and follow objects in both the PCCC- group and the PPPC+ group (9.6% to 92.3% and 6.1% to 90.9% [both P < 0.001]).

CONCLUSIONS

Combined capsulectomy and anterior vitrectomy markedly reduces and delays PCO compared to PCCC alone, with equivalent visual gains.