Management of congenital cataract in children younger than 1 year using a 25-gauge vitrectomy system.

PURPOSE: To evaluate the safety and efficacy of a 25-gauge vitrectomy system for the management of congenital cataract in children younger than 1 year.

SETTING

Princess Margaret Hospital for Children, Western Australia, Australia.

METHODS

Children in a tertiary pediatric hospital and private practice had cataract extraction using a 25-gauge vitrectomy system between January 2005 and June 2008. Each eye had anterior vitrectorhexis, lens aspiration, posterior vitrectorhexis, and anterior vitrectomy through two 25-gauge limbal side ports. The ports were created with a 25-gauge trocar or a 0.6 mm paracentesis knife. The eyes were left aphakic.

RESULTS

Nineteen (95%) of the 20 eyes (14 children) had a successful surgical outcome with the 25-gauge vitrectomy system. One eye was converted to the 20-gauge system because of an unusually tough and fibrous lens capsule. The limbal side ports in 16 of 17 eyes created with the 25-gauge trocar required suturing to seal the ports; none of the 3 eyes with side ports created with the paracentesis knife required suturing. There were no significant intraoperative or postoperative complications other than ocular hypertension in 1 eye.

CONCLUSIONS

The 25-gauge vitrectomy system appears safe and effective for the management of infantile cataract. Advantages include more precise manipulations with smaller instruments in infant eyes, a more stable anterior chamber, and less postoperative astigmatism.