Objective To evaluate the safety and efficacy of a 23-gauge transconjunctival sutureless vitrectomy system for the management of traumatic cataract in children and to determine the short-term outcome and complications. Methods This retrospective study involved a consecutive series of 32 children （32 eyes） who suffered from traumatic cataract from March 2009 to September 2011. Each eye underwent anterior capsulotomy， lentectomy， posterior capsulotomy， and anterior vitrectomy through a superior limbal incision using a 23-gauge vitrectomy cutter. A limbal port incision was used to introduce an infusion micro cannula to maintain the anterior chamber with balance salt solution. The superior limbal incision was enlarged to 2.75 mm by a diamond knife. An intraocular lens （IOL） was implanted in the bag or sulcus. The enlarged incision was closed with one or two 10-0 nylon suture. Refraction correction with spectacles and amblyopic training began 1 week postoperatively. The mean follow-up period was 17.1±8.2 months. Results All the surgical procedures were successfully performed in all 32 eyes. No intraoperative complication was noted. The mean postoperative intraocular pressure （IOP） was 12.9±2.4 mmHg. Postoperative inflammation was mild. No fibrin reactions， vitreous escape or incarceration were noted in the anterior chamber. Neither significant aqueous flare nor aqueous cell was observed 1 week after surgery. Five eyes （15.6%） had mild posterior synechiae. All eyes had primary IOL implantation. IOL was implanted in the bag in 22 eyes （68.7%） and in the sulcus in 10 eyes （31.3%）. The mean axial length of the 32 eyes was 22.36±1.03 mm at the time of operation and the mean IOL power was +22.97±1.89 D. Four eyes （12.5%） developed visual axis opacification （VAO） and required capsulotomy by YAG laser. IOL pigmentation was noted in 5 eyes （15.6%）. No cases of ocular hypertension， glaucoma， choroidal detachment or retinal detachment were observed. The mean logMAR best corrected visual acuity （BCVA） was 2.37±1.16 preoperatively and 0.39±0.48 at the last follow-up， BCVA was significantly improved （t=10.916， P<0.01）. BCVA was improved in 29 eyes postoperatively. The predictors of good visual outcomes （BCVA≥20/40） included metal as the object causing injury， cataract operation within 3 month after injury and good amblyopic treatment （Fisher=0.028， 0.047， 0.000， respectively. P<0.05）. Conclusion Management of traumatic cataract in children via an anterior approach using the 23-gauge transconjunctival sutureless vitrectomy system appears safe and effective. Advantages include a more precise capsulotomy and more sufficient lensectomy and anterior vitrectomy， stable intraoperative IOP， and reduced surgical trauma and inflammation.
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