Pediatric Cataract Surgery: Microsurgical Technique

All surgeries were performed under general anesthesia by one experienced surgeon (Y. Luo) using the Millennium Microsurgical System (Alcon, Fort Worth, TX, USA) and the 25-gauge microincision vitrectomy system. The surgical procedures were described in our previous studies [10 (link),11 (link)]. Briefly, a 25-gauge infusion cannula was inserted through the 4 or 8 o’clock limbal incision to maintain the anterior chamber with a balanced salt solution (BSS; Alcon). A cutting tip of the 25-gauge vitrectomy instrument was introduced through an incision at the 12 o’clock position. A central anterior capsulotomy of 5.0–5.5 mm diameter was created using the vitrector. Lens material was removed at a cutting rate of 600 cuts per minute and a maximum suction pressure of 400 mmHg (Figure 1a). A posterior capsulotomy of 4.0–4.5 mm diameter was created, followed by a limited anterior vitrectomy (Figure 1b). The microcannula at the 12 o’clock incision was then removed, and the incision was enlarged to 2.6 mm. After the ophthalmic viscosurgical device (OVD) (DisCoVisc; Alcon) was injected, a one-piece acrylic foldable IOL (AcrySof SA60AT; Alcon) was implanted into the capsular bag (Figure 1c). The limbal incision was closed with one or two 10–0 nylon sutures (Ethilon 9033; Allmedtech, Beverley Hills, CA, USA), and the corneal stroma at the limbal side port was hydrated with BSS after removal of the infusion cannula. The fellow eye was operated on a week after the first eye surgery.
The Barrett universal II formula was used to calculate the IOL power. In consideration of future axial growth, the target IOL power was chosen according to the child’s age using a scale, suggesting under-powering by +6 D at 1 year of age and decreasing 1 D per year, excepting no correction was specified for children 7 years and older (Table 1).