Ruiz-Justiz Armando J, Cruz-Villegas Vanessa, Schwartz Stephen G, Villegas Victor M, Murray Timothy G
Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Medicina (Kaunas). 2025 Jun 29;61(7):1176. doi: 10.3390/medicina61071176.
To review the current literature on the combined use of cataract surgery (or lensectomy) and vitrectomy in pediatric patients, with a focus on clinical indications, surgical techniques, outcomes, and complications across various pediatric ocular pathologies. A narrative review of published studies addressing the use of combined lensectomy and vitrectomy (LV) in pediatric patients was conducted. Conditions discussed include congenital cataracts, ectopia lentis, retinopathy of prematurity (ROP), retinal detachment (RD), and persistent fetal vasculature (PFV). Key surgical considerations, visual and anatomical outcomes, and postoperative complications were examined. The literature search yielded a total of 160 articles, of which 43 met the inclusion criteria and were included in this review. Although lens-sparing vitrectomy (LSV) is preferred in many pediatric cases to preserve accommodation and reduce complications, combined LV is often necessary in advanced or complex diseases. Studies have shown that combined LV can achieve favorable anatomical outcomes, but functional visual recovery remains variable and is affected by factors such as patient age, baseline ocular anatomy, and disease severity. Postoperative complications such as glaucoma, visual axis opacification (VAO), and intraocular lens (IOL) dislocation are more frequent with combined procedures and require long-term follow-up and rehabilitation. Combined cataract surgery (or lensectomy) and vitrectomy may represent a valuable strategy in the management of complex pediatric ocular conditions, particularly when individualized to the clinical context. Tailored surgical approaches are essential to optimize anatomic and functional outcomes. Further prospective studies and harmonized multicenter registries are needed to develop evidence-based principles that can guide individualized surgical decision-making in this unique patient population.
回顾目前关于小儿患者白内障手术（或晶状体切除术）与玻璃体切除术联合应用的文献，重点关注各种小儿眼部疾病的临床适应证、手术技术、疗效及并发症。对已发表的关于小儿患者晶状体切除术与玻璃体切除术联合应用（LV）的研究进行叙述性综述。讨论的疾病包括先天性白内障、晶状体异位、早产儿视网膜病变（ROP）、视网膜脱离（RD）和永存原始玻璃体增生症（PFV）。研究了关键手术要点、视觉和解剖学疗效以及术后并发症。文献检索共获得160篇文章，其中43篇符合纳入标准并纳入本综述。尽管在许多小儿病例中，保留晶状体的玻璃体切除术（LSV）更受青睐，以保留调节功能并减少并发症，但在晚期或复杂疾病中，联合LV手术往往是必要的。研究表明，联合LV手术可取得良好的解剖学疗效，但功能性视力恢复仍存在差异，且受患者年龄、基线眼部解剖结构和疾病严重程度等因素影响。联合手术术后并发症如青光眼、视轴混浊（VAO）和人工晶状体（IOL）脱位更为常见，需要长期随访和康复治疗。联合白内障手术（或晶状体切除术）与玻璃体切除术可能是治疗复杂小儿眼部疾病的一种有价值的策略，尤其是根据临床情况进行个体化治疗时。量身定制的手术方法对于优化解剖学和功能性疗效至关重要。需要进一步的前瞻性研究和统一的多中心登记，以制定基于证据的原则，指导这一特殊患者群体的个体化手术决策。
