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Surgery for cataracts that develop in both eyes at or soon after birth

To have a cataract describes a condition where the normally clear lens inside the eye is cloudy and obscures vision. Cataracts that develop at or soon after birth in both eyes are a major cause of childhood blindness in the world, especially in developing countries. Treatment is indicated if the cataract prevents normal vision. This can be assessed by measuring how much the child can see and looking into the eye at the cataract. The only way to correct the cataract is to surgically remove it. It is generally accepted that early surgery results in a greater chance of good vision. There are two main approaches to surgery: lensectomy and lens aspiration. Lensectomy removes the entire lens and some of the gel which fills the eye (anterior vitrectomy); lens aspiration removes the lens but leaves the posterior lens capsule intact. A significant complication from surgery is re‐clouding of the central passage for vision (visual axis opacification (VAO)). All surgical procedures aim to reduce this and the need for further treatment. Removing the cataract leaves the eye without the ability to focus. This must be corrected as soon as possible after surgery using intraocular lenses (IOL), contact lenses or spectacles, or a combination. The aim of the review was to clarify which surgical approach resulted in the best visual improvement. We searched for studies where children with cataract at or soon after birth had been randomised to receive a type of surgical procedure. The primary outcome was the level of vision after surgery. In the four included randomised studies the type of surgical procedure made no real difference to the final vision but there were differences in the number of children who developed VAO. Procedures which appeared to reduce VAO were anterior vitrectomy (removing some of the gel which fills the eye) and optic capture (lodging the lens portion of the IOL into an opening created in the posterior capsule). Three of the four studies used IOLs to correct aphakia, an option increasingly popular but which may not be suitable in regions where careful follow up cannot be guaranteed. While there is evidence for successful surgical treatment of this type of potentially blinding cataract, there is a lack of good evidence regarding aspects of its delivery such as the best timing for surgery and the appropriate method for aftercare.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Mitomycin C versus 5‐Fluorouracil for wound healing in glaucoma surgery

Raised intraocular pressure is a risk factor for glaucoma. One treatment option is glaucoma drainage surgery (trabeculectomy) to help lower intraocular pressure. Antimetabolites are medicines used during surgery to help reduce scarring after surgery during wound healing. If scarring occurs it can lead to treatment failure because the drainage channel no longer works. Two agents in common use are MMC and 5‐FU.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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