الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Childhood cataracts are responsible for 5–20 % of blindness in children worldwide and for an even higher percentage of childhood visual impairment in developing countries.
In this study out of 116 patients (142 eyes) who started the study, only 75 patients (97 eyes) completed the 2-years follow up period.
All patients were subjected to Complete medical history and physical examination, Complete ophthalmological evaluation, including visual acuity assessment (if possible) , anterior segment examination by slit-lamp ,fundus examination after pupillary dilatation (if cataract density allowed) to exclude associated posterior segment anomalies , IOP under general anesthesia and Ultrasound examination: (A- and B- scan) was performed under sedation or UGA to exclude posterior segment pathology.
Patients were divided into 3 groups based on the surgical technique they had undergone. group A ”25 patients” are patients who have undergone Lensectomy anterior vitrectomy (LAV). GroupB ”24 patients” are patients who have undergone Extracapsular cataract extraction, primary posterior capsulorhexis or capsulotomy, anterior vitrectomy, and IOL implantation (ECCE/PPC/AV/IOL), group C ”26patients” are patients who have undergone Extracapsular Cataract Extraction and IOL Implantation (ECCE/IOL)
The rationale for follow up was 3days in the hospoital , weekly for 3 weeks , monthly for 3 months then after one and two years ,to measure the best corrected visual acuity and to report all possible complications
All patients of group A were not assessed for visual acuity due to age limitations, Visual acuity at one month postoperatively was possible to asses in only 37 eyes , uncorrected visual acuity was better than 6/60 in 27 eyes ;13 in group B and 14 in group C.
Acuity of 1/60 to 6/60 was measured in 5 eyes; 3 in group B and 2 in group C. The remaining 5 eyes had visual acuity less than 1/60 and this was attributed to amblyopia.
Postoperative iritis occurred in 7 eyes with mild inflammatory reaction. All affected eyes treated with more frequent topical prednisolone acetate 1% , Striate keratopathy was found in 4 eyes and cleared after frequent topical steroid application, Postoperative end-ophthalmitis: occurred in one eye in group A in the second postoperative day and treated immediately by intravitreal injection of antibiotic.
Twenty-four hours later, 3 ports pars plana vitrectomy was done but unfortunately the eye passed into atrophia,
Hyphema occurred in 4 eyes (4.12%), 2 eyes (2.1%) in group A, 1 (1%) in group B and 1 (1%) in group C. In all cases, the hyphema spontaneously resolved within 3 days.
Secondary glaucoma occurred in 8 eyes ; 3 aphakic and 5 pseudophakic .Intraocular pressure (IOP) was controlled medically during the study period; medically in 6 eyes (6.1%) and by surgically in the remaining 2 eyes (2.1%),
Posterior capsule opacification (PCO) occurred in 30 eyes during the first 3 months of follow up. Seven eyes belonged to group A.,In group B, 5 eyes had PCO; all with PMMA IOL; no PCO occurred in the 16 eyes that were implanted acrylic IOL and the optic of the IOL was captured into the posterior capsulorrehxis, For group C, PCO was recognized in 18 eyes
Sixteen eyes with PCO were managed by YAG posterior capsulotomy during the first 6 months postoperatively. These included 2 eyes in group B, and 14 in group C.
The remaining 14 eyes required surgical posterior capsulotomy; 7 in group A, 3 in group B and 4 in group C,
Late IOL capture occurred in 9 eyes (9.3%). These included 5 eyes (5.2%) in group B; among them 4 eyes (4.1%) had been implanted PMMA IOL and were successfully managed by mydriasis in 2 (2%) and by surgical repositioning in the other 2 (2%). The fifth eye (1%) had been implanted foldable IOL and was managed successfully by mydriasis. ,In group C, late IOL capture occurred in 4 eyes (4.1%), among them 3 eyes (3.1%) had been implanted PMMA IOL and were successfully managed by mydriasis in one eye (1%), and surgically in another eye (1%) while no intervention was done in the third eye due to family refusal. The fourth eye (1%) had been implanted foldable IOL and was successfully managed by mydriasis.
Lastly this study recommends , The routine uses of highly viscous OVDs, anterior and posterior continuous curvilinear capsulorrhexes, in-the-bag or bag-in-the-lens implantation and modem-design foldable acrylic IOLs significantly improves outcomes in pediatric cataract surgery, IOL implantation at primary cataract surgery helps to prevent development of secondry glaucoma, but increases the number of interventions for VAO in infants, Complications after cataract surgery in children are often associated with an inflammatory reaction or secondary opacity and glaucoma. Late complications can occur decades later, so that long-term follow-up is required. Though surgery carries significant risks, the consequences of no surgery and irreversible deprivation amblyopia in very young children should be considered.