PURPOSE: To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye. SETTING: Filatov Institute, Odessa, Ukraine. METHODS: Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed. RESULTS: Children in the younger age group (
Indigenous ocular flora has been presumed to be a source of infectious organisms in postoperative bacterial endophthalmitis. While bacteria have been recovered from the anterior chamber at the time of cataract wound closure in a significant percentage of cases, and bacteria from the vitreous of endophthalmitis cases have appeared genetically to be very similar to bacteria recovered from the adnexa and/or nares at the time of vitrectomy for endophthalmitis, no study has examined the relationship between organisms isolated from the eyelid and conjunctiva, and organisms recovered from the aqueous humor at the time of wound closure. This study examined 59 eyes undergoing cataract and other intraocular surgeries. Cultures of the eyelids and conjunctiva were taken before and after routine preparation with povidone-iodine solution. Cultures also were taken of the aqueous humor at the time of incision into the anterior chamber and at the time of wound closure. No organisms grew from aqueous humor samples taken at the time of incision. However, 13 eyes (22%) grew gram-positive organisms from samples taken at the time of wound closure. Eight of the 13 eyes (62%) had organisms with identical typing and antibiotic sensitivities to organisms isolated from the eyelids and conjunctiva before or after disinfection. This study suggests that a significant number of cases had inoperative bacterial contamination of the aqueous humor by the time of wound closure and that organisms from the eyelids and conjunctiva are an important source of contamination in these cases.
PURPOSE: To evaluate after-cataract formation in children having cataract surgery with or without dry anterior vitrectomy and possible differences according to age. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This retrospective study comprised 85 eyes of 85 patients from 0 to 15 years old who had cataract surgery with or without anterior vitrectomy after the implantation of an intraocular lens (IOL). All patients had primary posterior capsulorhexis but no optic capture. Thirty-five patients received a heparin-surface-modified poly(methyl methacrylate) IOL (809C, Pharmacia & Upjohn) and 50 patients, a foldable acrylic IOL (AcrySof(R), Alcon). The records from follow-up visits at the patients' home clinics were used for analysis. RESULTS: Significantly fewer children were operated on for after-cataract if they had cataract surgery with anterior vitrectomy (P .05). CONCLUSION: In children younger than 7 years with an AcrySof IOL, the rate of after-cataract surgery was significantly less in those who had an anterior vitrectomy at the time of cataract surgery (P