Paediatric cataract surgery with 27G vitrectomy instrumentation: the Ghent University Hospital Experience

Objective

To describe a cohort of paediatric patients who underwent unilateral or bilateral lens extractions at Ghent University hospital using the Dutch Ophthalmic Research Center (D.O.R.C.) ultra-short 27G vitrectomy system.

Methods

Retrospective analysis of the medical and surgical records of all children that underwent lens extraction between September 2016 and September 2020 using the D.O.R.C. ultra-short 27G vitrectomy system.

Results

Seventy-two eyes of 52 patients were included. The most important aetiologies in this study were of secondary (25.5%), developmental (13.7%), or genetic (13.7%) nature. No definitive cause could be established in more than a quarter of cases (27.5%) despite extensive work-up, them being deemed idiopathic. The remainder of cases (19.6%) was not assigned a final aetiologic designation at the time of the study due to contradicting or missing diagnostic data. This study could not identify any cataract cases related to infection or trauma. Surgical complications rate was 61.1% of which posterior capsule opacification was the most frequent with a rate of 25%. A significant short-term postoperative best-corrected visual acuity gain (≤ -0.2 LogMAR) was observed in 60.5% of eyes for which usable acuity data were available (n = 38).

Conclusion

Many different instruments and techniques have been described and used in the context of paediatric lens extractions, each with its advantages and disadvantages. This study illustrates that an ultra-short 27G vitrectomy system can be used to perform paediatric lens extractions with good surgical outcomes. Further studies and comparative trials are needed to ascertain this further.

Cystoid Macular Edema Following Cataract Surgery with Low-Energy Femtosecond Laser versus Conventional Phacoemulsification

Purpose

To compare postoperative changes in central subfield macular thickness (CSMT) and prevalence of cystoid macular edema (CME) in patients undergoing cataract surgery with low-energy femtosecond laser versus standard phacoemulsification.

Design

This was a retrospective comparative real-world study.

Methods

Postoperative data of 252 eyes of 165 patients were collected: 138 eyes received low-energy femtosecond laser-assisted cataract surgery (FLACS) and 114 eyes underwent conventional phacoemulsification cataract surgery (CPCS). Postoperative changes in CSMT and prevalence of CME were compared between the two groups.

Results

There was a significant increase in mean CSMT from preoperative to postoperative values at 2.5 months in both the FLACS and CPCS group (p<0.001). Mean change (preoperation to 2.5 months postoperation) in CSMT was 6.2±11.5 µm in the FLACS group and 7.3±26.6 µm in the CPCS group, which was statistically significant but clinically not relevant. Comparison of mean changes in CSMT (preoperation to 2.5 months postoperation) between the FLACS and CPCS groups revealed no significant differences. The rate of pseudophakic CME (PCME) development was lower in the FLACS group (1.4%) than the CPCS group (4.4%; p=0.247). When using PREMED criteria to define clinically significant PCME, only 0.7% patients in the FLACS group and 1.8% in the CPCS group showed development of clinically significant PCME (p=0.586).

Conclusion

The mean change in CSMT and occurrence of postoperative CME was lower in the low-energy FLACS group than the standard-phacoemulsification group; however, the difference was not statistically significant.