Dear Editor,

We have read Dericioğlu et al.’s¹ study entitled “Predictive Factors of Complications and Visual Outcomes after Pediatric Cataract Surgery: A Single Referral Center Study from Türkiye” with great interest. However, we would like to share with our colleagues some issues that we believe will be useful for the entire readership and are important to clarify.

Pediatric cataract surgery involves serious intraoperative and postoperative complications, and the management of surgery remains a challenging issue for surgeons.² The first of these problems is whether the patient will be left aphakic or an intraocular lens (IOL) will be implanted. The authors left some of the patients older than 12 months (group IIA, n=21 eyes) as aphakic. Among these patients, were there cases in which the integrity of the capsular bag was completely disrupted and was scleral IOL fixation considered in these cases? On the other hand, according to their results, pseudophakic eyes (0.49±0.40 logarithm of the minimal angle of resolution [logMAR]) had significantly better final best-corrected visual acuity than aphakic eyes (0.65±0.59 logMAR). This reflects that IOL implantation is important for better visual outcomes in patients older than 12 months.

The authors reported pupillary membrane development in 5 cases (4 [10.5%] in group 1 and 1 [4.8%] in group 2), and the postoperative treatment protocol included the use of 1% prednisolone acetate four times a day for one month. To avoid this complication, we would like to underline that, in addition to a more intense topical anti-inflammatory treatment protocol, intraoperative intracameral triamcinolone acetonide, which we frequently use in pediatric cataract surgery in our clinical practice, can be extremely beneficial.^3,4

On the other hand, the authors performed posterior continuous curvilinear capsulorhexis (CCC) in all cases and stated that they did not perform anterior vitrectomy except for unintentional anterior hyaloid rupture. They also reported visual axis opacification in 8 cases (4 [10.5%] in group 1 and 4 [19.0%] in group 2) in the postoperative period. In order to overcome this problem, prevent visual axis opacification, and avoid serious vitreous-related complications after anterior vitrectomy, it has been reported that posterior optic capture (optic capture buttonholing) combined with posterior CCC can be an effective and safe alternative, without routinely performing anterior vitrectomy.⁵

Once again, we congratulate the authors for this new and different study, and we think that prospective, randomized advanced clinical studies with more pediatric cataract patients from multiple centers in the future will further shed light on this issue.

Ethics

Financial Disclosure: The author declared that this study received no financial support.