Letter to the Editor

Letter to the Editor Re: Predictive Factors of Complications and Visual Outcomes after Pediatric Cataract Surgery: A Single Referral Center Study from Türkiye


  • Fikret Uçar

Received Date: 10.11.2023 Accepted Date: 06.12.2023 Turk J Ophthalmol 2024;54(1):52-53 PMID: 38385321

Keywords: Congenital cataract, aphakia, visual outcomes, complications, posterior optic capture

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.


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

  1. Dericioğlu V, Sevik MO, Bağatur Vurgun E, Çerman E. Predictive Factors of Complications and Visual Outcomes after Pediatric Cataract Surgery: A Single Referral Center Study from Türkiye. Turk J Ophthalmol. 2023;53:267-274.
  2. Vasavada AR, Nihalani BR. Pediatric cataract surgery. Curr Opin Ophthalmol. 2006;17:54-61.
  3. Chou YY, Zhang BL, Gan LY, Ma J, Zhong Y. Efficacy of intracameral preservative-free triamcinolone acetonide in pediatric cataract surgery: a meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2020;258:2205-2212.
  4. Ucar F. Intraocular lens implantation with flattened flanged intrascleral fixation technique in pediatric aphakia. J AAPOS. 2022;26:8.e1-8.e7.
  5. Kohnen T, Davidova P, Lambert M, Wenner Y, Zubcov AA. Posterior continuous curvilinear capsulorhexis with anterior vitrectomy vs optic capture buttonholing without anterior vitrectomy in pediatric cataract surgery. J Cataract Refract Surg. 2022;148:831-837.