journal of mtu Journal of Medical Topics and Updates 2822-4094 Malatya Turgut Ozal University Clinical Sciences Klinik Tıp Bilimleri Konjenital katarakt cerrahisinde totale yakın posterior kapsülotomi: yeni bir cerrahi yaklaşım Near-total posterior capsulotomy in congenital cataract surgery: a novel surgical approach https://orcid.org/0000-0003-1752-6810 Gündüz Abuzer MALATYA TURGUT OZAL UNIVERSITY, SCHOOL OF MEDICINE https://orcid.org/0000-0002-3590-3213 Öztürk Emrah MALATYA TURGUT OZAL UNIVERSITY, SCHOOL OF MEDICINE https://orcid.org/0000-0003-3279-9737 Ozsoy Ercan University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey 04 29 2022 1 1 14 19 04 10 2022 04 23 2022 Copyright © 2022, Journal of Medical Topics and Updates 2022 Journal of Medical Topics and Updates

Amaç: Konjenital katarakt cerrahisinde lens aspirasyonu ve anterior vitrektomiye ile birlikte uygulanan parsiyel posterior kapsülotomi yerine totale yakın posterior kapsülotomi yaklaşımını tanımlamak.Materyal ve Metot: Bu çalışma üçüncü basamak bir merkezde yürütülmüştür. Ocak 2010-Eylül 2018 tarihleri arasında konjenital katarakt tedavisi için totale yakın posterior kapsülotomi, lens aspirasyonu ve anterior vitrektomi uygulanan 11 hasta çalışmaya dahil edildi. Ameliyat endikasyonu lentiküler lökokori olarak tanımlandı. Tanı anında altı aydan büyük olan ve takip süresi altı aydan az olan hastalar çalışmaya dahil edilmedi. Cerrahi başarı, postoperatif 6. ayda merkezi görmel aksın açık olması olarak tanımlandı.Bulgular: Konjenital katarakt nedeniyle opera edilen 11 hastanın toplam 22 gözü çalışmaya dahil edildi. Tüm hastaların her iki gözüne aynı seansta ameliyat uygulandı. Hastaların tanı anındaki ortalama yaşı 2.89 ± 1.8 ay iken operasyon esnasındaki ortalama yaşı 3.70 ± 1.84 aydı. Ortalama takip süresi 16.54 ± 14.96 (8-48) aydı. Cerrahi esnasında hiçbir hastada komplikasyon izlenmedi. Takipler esnasında hiçbir hastada görsel aksı kapatan bir opasite izlenmedi.Sonuç: Totale yakın posterior kapsülotomi kolay ve güvenilir bir cerrahi tekniktir. Bu teknik ile görsel aks opasiteleri azaltılabilir.

Background: To define near-total posterior capsulotomy instead of partial posterior capsulotomy with lens aspiration and anterior vitrectomy in congenital cataract surgery.Materials and Methods: The research was carried out in a tertiary care center. Eleven patients who underwent near-total posterior capsulotomy, lens aspiration, and anterior vitrectomy surgery for treatment of congenital cataract between January 2010 and September 2018 were included in the study. Lenticular leukocoria was accepted as an indication for surgery. Patients who were older than six months at diagnosis and had a follow-up time of less than six months were excluded from the research. Surgical success was defined as the presence of a clear central visual axis in postoperative 6th months.Results: The study included 22 eyes from 11 cataract surgery patients due to congenital cataracts. Both eyes of all patients underwent surgery in the same session. At the time of diagnosis, the average age of the patients was 2.89 ± 1.8 months, and at the time of surgery, the mean age of the patients was 3.70 ± 1.84 months. The average follow-up time was 16.54 ± 14.96 (8-48) months. Intraoperative complications did not occur in any patient. Visual axis opacification was not observed in any patient during the follow-up.Conclusions: Near-total posterior capsulotomy is an easy and safe surgical technique. It could reduce the visual axis opacification.

 Anterior Vitrectomy Congenital Cataract Lens Aspiration Posterior Capsulotomy Visual Axis Opacification Posterior kapsulotomi Anterior Vitrektomi Görsel Aks Opasitesi Konjenital Katarakt Lens Aspirasyonu yok yok A Dholakia, S., R Praveen, M., Vasavada, A., & Nihalani, B. (2006). Completion rate of primary posterior continuous curvilinear capsulorhexis and vitreous disturbance during congenital cataract surgery. Journal of AAPOS: The Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus, 10, 351-356. Andreo, L.K., Wilson, M.E. & Apple, D.J. (1999). Elastic properties and scanning electron microscopic appearance of manual continuous curvilinear capsulorhexis and vitrectorhexis in an animal model of pediatric cataract. Journal of Cataract & Refractive Surgery, 25(4), 534-539. Birch, E.E., Cheng, C., Stager, D.R., Jr., Weakley, D. R., Jr. & Stager, D.R., Sr. (2009). The critical period for surgical treatment of dense congenital bilateral cataracts. J AAPOS, 13(1), 67-71. Borghol-Kassar, R., Menezo-Rozalen, J. L., Harto-Castano, M.A. & Desco-Esteban, M.C. (2012). [Assessment of intra-operative techniques to prevent visual axis opacification in congenital cataract surgery]. Arch Soc Esp Oftalmol., 87(10), 315-319. Gilbert, C. (2007). Changing challenges in the control of blindness in children. Eye (Lond), 21(10), 1338-1343. Jensen, A.A., Basti, S., Greenwald, M.J. & Mets, M.B. (2002). When may the posterior capsule be preserved in pediatric intraocular lens surgery? Ophthalmology, 109(2), 324-327. Khokhar, S., Sharma, R., Patil, B., Sinha, G., Nayak, B. & Kinkhabwala, R.A. (2015). A safe technique for in-the-bag intraocular lens implantation in pediatric cataract surgery. Eur J Ophthalmol., 25(1), 57-59. Knight-Nanan, D., O'Keefe, M. & Bowell, R. (1996). Outcome and complications of intraocular lenses in children with cataract. J Cataract Refract Surg., 22(6), 730-736. Kochgaway, L., Biswas, P., Paul, A., Sinha, S., Biswas, R., Maity, P. & Banerjee, S. (2013). Vitrectorhexis versus forceps posterior capsulorhexis in pediatric cataract surgery. Indian J Ophthalmol., 61(7), 361-364. Lambert, S.R., Buckley, E.G., Plager, D.A., Medow, N.B, & Wilson, M.E. (1999). Unilateral intraocular lens implantation during the first six months of life. J AAPOS, 3(6), 344-349. Lambert, S.R. & Drack, A.V. (1996). Infantile cataracts. Surv Ophthalmol., 40(6), 427-458. Lambert, S.R., Lynn, M., Drews-Botsch, C., DuBois, L., Wilson, M.E., Plager, D.A. & Donahue, S.P. (2003). Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members. J AAPOS, 7(6), 400-405. Lim, M. E., Buckley, E.G. & Prakalapakorn, S.G. (2017). Update on congenital cataract surgery management. Curr Opin Ophthalmol., 28(1), 87-92. Luo, Y., Lu, Y., Lu, G. & Wang, M. (2008). Primary posterior capsulorhexis with anterior vitrectomy in preventing posterior capsule opacification in pediatric cataract microsurgery. Microsurgery, 28(2), 113-116. Mills, M.D. & Robb, R.M. (1994). Glaucoma following childhood cataract surgery. J Pediatr Ophthalmol Strabismus, 31(6), 355-360. Murphy, M., Murtagh, P., McAnena, L., Eldouri, A., Kirwan, C. & O'Keefe, M. (2019). Secondary glaucoma and visual axis opacification in aphakic and pseudophakic patients following congenital cataract surgery: A 28-year longitudinal case series. Eur J Ophthalmol., 1120672119862878. Nischal, K.K. (2002). Two-incision push-pull capsulorhexis for pediatric cataract surgery. Journal of Cataract & Refractive Surgery, 28(4), 593-595. Nishi, O. (1988). Fibrinous membrane formation on the posterior chamber lens during the early postoperative period. J Cataract Refract Surg., 14(1), 73-77. Petric, I. & Lacmanovic Loncar, V. (2004). Surgical technique and postoperative complications in pediatric cataract surgery: retrospective analysis of 21 cases. Croat Med J., 45(3), 287-291. Praveen, M.R., Vasavada, A.R., Koul, A., Trivedi, R. H., Vasavada, V.A. & Vasavada, V.A. (2008). Subtle signs of anterior vitreous face disturbance during posterior capsulorhexis in pediatric cataract surgery. Journal of Cataract & Refractive Surgery, 34(1), 163-167. Raina, U.K., Gupta, V., Arora, R. & Mehta, D.K. (2002). Posterior continuous curvilinear capsulorhexis with and without optic capture of the posterior chamber intraocular lens in the absence of vitrectomy. J Pediatr Ophthalmol Strabismus, 39(5), 278-287. Ram, J., Brar, G.S., Kaushik, S., Gupta, A. & Gupta, A. (2003). Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery. J Cataract Refract Surg., 29(8), 1579-1584. Simon, J.W., Mehta, N., Simmons, S.T., Catalano, R. A. & Lininger, L.L. (1991). Glaucoma after pediatric lensectomy/vitrectomy. Ophthalmology, 98(5), 670-674. Taylor, D. (1998). The Doyne Lecture. Congenital cataract: the history, the nature and the practice. Eye (Lond), 12 ( Pt 1), 9-36. Vasavada, A. & Desai, J. (1997). Primary posterior capsulorhexis with and without anterior vitrectomy in congenital cataracts. J Cataract Refract Surg., 23 Suppl 1, 645-651. Vasavada, A.R. & Trivedi, R.H. (2000). Role of optic capture in congenital cataract and intraocular lens surgery in children. J Cataract Refract Surg., 26(6), 824-831. Weakley, D.R., Jr., Lynn, M.J., Dubois, L., Cotsonis, G., Wilson, M.E., Buckley, E.G., . . . & Lambert, S.R. (2017). Myopic shift 5 years after intraocular lens implantation in the infant aphakia treatment study. Ophthalmology, 124(6), 822-827. Zetterstrom, C., Lundvall, A. & Kugelberg, M. (2005). Cataracts in children. J Cataract Refract Surg., 31(4), 824-840.