Comparative analysis of endothelial cell characteristics in two techniques of posterior capsular management in pediatric cataract.

Abstract

Dear Editor, An important complication after pediatric cataract surgery is posterior capsular opacification (PCO), and primary posterior capsulotomy (PPC) is an imperative step to prevent it. Two popular techniques to perform PPC are manual “posterior continuous curvilinear capsulorhexis” (PCCC) using Utrata forceps and “limbal approach retropseudophakic vitrectorrhexis” (LARV) using vitrector.[1] This additional step can potentially worsen postoperative inflammation and endothelial cell damage. Various studies have reported endothelial cell characteristics before and after cataract surgery in children,[2345] but none have so far compared two different techniques of PPC. Each technique has its advantages, such as in PCCC, the viscosurgical device coats the endothelium during PPC, thereby protecting it from damage. LARV is simpler to perform, although endothelium gets continuously exposed to balanced salt solution. The aim of our study was to analyze changes in corneal endothelial cell characteristics in pediatric cataract, comparing manual PCCC before intraocular lens (IOL) implantation and LARV after IOL implantation. A prospective comparative study was done in 60 eyes of 30 patients with bilateral developmental cataract (3–8 years of age) undergoing cataract surgery from April 2017 to September 2017. The same patient underwent PPC via manual PCCC technique in the first eye and via LARV technique in the second eye. Topcon SP3000P non-contact endothelial specular microscopy was used for endothelial analysis. The baseline characteristics of both groups were comparable [Table 1]. Endothelial cell loss was less than 4% after 3 months in both groups, and all other specular microscopic endothelial parameters were also comparable [Table 2]. Surgical time is a known factor in causing endothelial cell loss, which was lesser in the LARV group. In conclusion, our study has shown that endothelial cell loss with conventional PCCC and LARV is comparable. Thus, use of any of these techniques can be left to surgeon’s discretion.Table 1: Comparison of baseline characteristicsTable 2: Comparison of preoperative and postoperative (Day 90) endothelial cell characteristicsFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.