Efficacy of plasma knife assisted posterior capsulotomy versus manual primary posterior capsulorhexis in preventing visual axis opacification in pediatric cataract surgery: A randomized controlled trial

Background: Posterior capsule opacification (PCO) is the commonest complication of extracapsular catraract surgery in pediatric patients with an incidence as high as 95%. But there is inadequate evidence on appropriate intervention to prevent PCO. Aim: To compare the efficacy of plasma knife assisted posterior capsulotomy versus manual primary posterior capsulorhexis in Pediatric Cataract surgery. Materials and methods: The current study was a randomized open labeled controlled study, conducted in the department of ophthalmology, All India Institute of Medical Sciences, New Delhi between July 2015 to June 2016. The study population included 32 children in each of < 2 years age, suffering from bilateral cataract and each eye was randomized to different intervention groups consisting of manual posterior capsulorhexis or and posterior capsulotomy using plasma knife. Anterior vitrectomy was performed in all the eyes. Visual acuity, axial length, Intra ocular pressure, and refraction etc. were measured using appropriate methods. The retro-illuminated clinical photograph was taken using NEW CARL ZEISS f340 CANON camera and was analyzed by EPCO software. Results: There was no statistically significant difference in any of the ocular parameters at baseline and at 6 months following surgery. The log MAR visual acuity was significantly higher in intervention 1 (0.465±0.143) as compare to intervention 2 (0.397 ± 0.108) at 1 year, which was statistically significant (P value 0.036). There were no statistically significant differences in the proportion of Visual Axis Opacification (VAO) between the intervention groups. Conclusion: Visual axis opacification after pediatric cataract surgery remains comparable in both techniques at one year (plasma knife assisted posterior capsulotomy and manual capsulorhexis). Hence it can be concluded that plasma knife assisted posterior capsulotomy does not have any added advantage over manual posterior capsulorhexis in preventing visual axis opacification.