الفهرس 
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Abstract
Any eye with anterior or posterior segment disease, previous ocular surgery or lens trauma or sublaxation is excluded. After taking a written consent from the parents, full medical and ocular history was taken, a detailed ocular examination was performed and B-scan to exclude any posterior segment abnormality. The procedure (Anterior capsulotomy, aspiration, posterior capsulotomy and anterior vitrectomy) was performed via posterior approach as group I or anterior approach as group II. A postoperative regimen of frequent topical steroids, antibiotics and topical Mydriatic cycloplegic, with gradual withdrawal of the steroids over three months. A scheduled follow up visits was regulated on the first day after surgery, first and second week, one, three and six months postoperative. This prospective randomized study was held in Mansoura Ophthalmic Center, Mansoura University in the period from 1/5/2016 to 30/6/2017. Thirty eyes of 22 children below the age of two years old with unilateral or bilateral visually significant cataract were included in the study. selection was done randomly by ”closed envelope” technique. Fifteen eyes were operated by posterior (pars plana) approach as study group (A) and the other fifteen eyes were operated by anterior (limbal) approach as study group (B). The follow up period was six months. Posterior capsular opacification (PCO), intraocular pressure (IOP) and signs of anterior chamber reaction were observed with special concern to the postoperative visual rehabilitation either by glasses for aphakic correction or by occlusion therapy. As regard the results of this comparative study between the posterior (pars plana) approach and the anterior (limbal) approach, there was no statistically significant difference as regard the postoperative anterior chamber reaction, secondary glaucoma or visual axis opacification (VAO). Although the posterior approach was much longer in the operative time (in minutes); 59.27 ± 12.69 in comparison with the anterior approach 39.93 ± 9.04, it is considered a safe and effective method for removal of congenital cataract especially if IOL implantation is not planned in the same setting (i.e. the child under the age of two years). This approach allows cataract removal with the least manipulations with the iris and subsequent iritis and inflammation. Being away from the corneal endothelium with preserving the stability of the anterior chamber intraoperative, all these factors improved the outcome as regard the postoperative corneal edema, the anterior chamber reaction as well as secondary glaucoma. In addition, the mentioned advantages of the posterior approach are the more precise capsulotomy and more sufficient lensectomy and anterior vitrectomy. This suture-less technique had helped a lot in reducing the surgical trauma, less postoperative inflammation, and faster postoperative recovery. For proper management of amblyopia, visual rehabilitation therapy either by glasses for correction of aphakia or occlusion therapy was applied strictly to the children in both study groups. Comparing the postoperative outcome between both groups, there was no statistically significant difference as regard VAO, secondary glaucoma and postoperative inflammation. However, pars plana approach may be superior in reducing the incidence of secondary glaucoma but additional studies with larger sample size and longer duration of follow up are needed. Although aphakia and the young age at time of operation are risk factors for secondary glaucoma development, secondary glaucoma can be reduced a lot by the technique, which guarantees the least manipulations with the iris and subsequent inflammation and the minimal disturbance to the angle structure. In addition, the intense postoperative medical regimen as well as parents’ compliance to the medications and follow up visits play a great role in decreasing the incidence of secondary glaucoma.