Clinical Analysis of Postoperative Complications Requiring Additional Surgeries after Congenital Cataract Surgery through Different Surgical Approaches

Abstract

Objective: To evaluate the postoperative complications and additional surgeries of limbal and pars plana approaches using microincision vitrectomy (25G/23G) for removal of congenital cataracts. Methods: In this retrospective cohort study, patients with a congenital cataract were referred to the Eye & ENT Hospital of Fudan University from March 2009 to December 2013. There, they underwent cataract surgeries through either the limbal approach or the pars plana approach. All of the surgeries were performed by one surgeon. For patients older than 1 year, primary intraocular lens implantation was performed. For patients younger than 1 year, secondary intraocular lens implantation was performed during follow-up after the initial cataract surgery. Complications and additional surgeries were recorded. Logistic regression was used to test the influence of potential risk factors on the incidence of postoperative complications. Fisher exact test was used to compare the incidence of postoperative complication between the different surgical approaches. Results: Of the 67 patients, 99 eyes with congenital cataract were included. The mean follow-up time was 4.4 years (range 0.9-8.3 years). Postoperative complications that required additional surgeries occurred 15 times in 11 eyes. These included 5 times of visual axis opacification in 5 eyes, 4 times of intraocular lens (IOL) pupillary capture in 3 eyes, 1 time of dislocation of IOL in vitreous in 1 eye, 2 times of retained cortex in 2 eyes, 2 times of pupillary membrane in 2 eyes, and 1 time of retinal detachment in 1 eye. Surgery at less than 1 year of age and surgery through the limbal approach were risk factors of complication requiring additional surgery (OR=17.9, P=0.009; OR=7.9, P=0.041; respectively). There was no statistical significance in the type of postoperative complications between the limbal approach and the pars plana approach (P>0.05). Conclusions: Age at surgery of less than 1 year and surgery through the limbal approach are the risk factors for postoperative complications requiring additional surgeries in patients with congenital cataract. The distribution of postoperative complications is not correlated with either of the two surgical approaches. Key words: congenital cataract; vitrectomy; postoperative complication