Pediatric cataract surgery in buphthalmos

Purpose: The pediatric eye offers many inherent surgical difficulties and when associated with a large buphthalmic eyeball, acts as a challenging ground for cataract surgeons. The purpose of our study is to describe the surgical outcome of cataract surgery in 6 children with buphthalmos. Methods: Eight eyes of 6 children with congenital glaucoma (buphthalmos) underwent phacoaspiration with or without intraocular lens (IOL) implantation. Demographic data, history of glaucoma surgery, intraocular pressure, biometry, surgical steps, and intraoperative and surgical outcome were noted for all patients from medical records. Postoperative outcome in terms of IOL stability, centration, visual acuity, and intraocular pressure were evaluated. Results: Pediatric cataract surgery was performed in 8 eyes with buphthalmos. Implantation of IOL was possible in 7/8 eyes. Primary posterior capsulorhexis (PPC) was done in 2/8 eyes. The IOL was implanted in the bag in 3 eyes and captured in 4 eyes. Decentration of IOL occurred in 100% of eyes where PPC was performed. Membranectomy for visual axis obscuration was done in 3 eyes. Conclusions: Standard IOLs remain stable and centered with endocapsular implantation or rhexis fixation of IOL after pediatric cataract surgery in buphthalmos. However, PPC should not be attempted in the same sitting, as it leads to decentration.