Pseudophakia for traumatic cataracts in children

All about traumatic cataracts: narrative review

Ocular trauma is an important cause of monocular blindness worldwide. Injury to the lens after blunt or penetrating trauma is common and can result in vision impairment. Selecting the most appropriate therapeutic approaches depends on factors such as patients' age, mechanism of trauma, and underlying clinical conditions. Early management, especially within childhood, is essential because of the difficulties involved in examination; anatomical variations; as well as accompanying intraocular inflammation, amblyopia, or vitreoretinal adhesions. The objective of this study was to provide a comprehensive review of the epidemiology and clinical management of traumatic cataract, highlighting the significance of accurate diagnosis and selection of the optimal therapeutic approach.

The Effect of Secondary Intraocular Lens Implantation Time on Visual Prognosis in Aphakia Cases After Open Globe Injury

Purpose

We investigated the effect of the time of secondary intraocular lens (IOL) implantation on final visual acuity and other causes affecting visual prognosis in cases left aphakic after open globe injury.

Methods

The study included 62 eyes of 62 patients left aphakic after the repair of open globe injury between 2012-2019. Demographic characteristics, trauma zone, ocular trauma score (OTS), type of injury, time of secondary IOL implantation, final best corrected visual acuity (BCVA), and complications were recorded for each patient.

Results

The mean follow-up time of 62 patients was 25.05 ± 12.59 months. The preoperative BCVA was found to be 2.40±0.86 LogMAR, while the postoperative final BCVA was found to be 0.53±0.70 LogMAR (p<0.01). The mean interval timing of secondary sulcus foldable IOL implantation was determined to be 3.79 ± 4.04 months. No correlation was observed between secondary IOL implantation time and final BCVA (r= 0.140, p=0.319). Furthermore, when only pediatric patients were taken, an excellent positive correlation was found between the secondary IOL implantation time and final BCVA LogMAR (r=0.895, p<0.01). Multiple linear regression on final BCVA with age, revealed a significant model explaining 48.0% of the variability with younger age and better final BCVA with as significant coefficients (p= 0.007).

Conclusion

Although time interval between primary repair and secondary IOL implantation to correct aphakia does not effect final BCVA in adult patients, earlier surgery should be considered for amblyopia management in pediatric patients.

Practice Patterns in the Surgical Management of Pediatric Traumatic Cataracts

PURPOSE

To facilitate the development of standardized guidelines for the surgical management of patients with pediatric traumatic cataracts by assessing current ophthalmologists' practice patterns.

METHODS

This was a cross-sectional, observational, and retrospective study. A 24-question electronic survey of current practices pertaining to the surgical management of pediatric traumatic cataracts was sent to pediatric ophthalmologists worldwide. Preferences for pre-operative evaluation, surgical timing and techniques, and postoperative management were analyzed.

RESULTS

Of the 56 respondents, 62.5% practiced in academic settings. Of the 49 respondents (87.5%) who performed pediatric ruptured globe repair, 41.7% would perform simultaneous cataract extraction if anterior capsular violation existed, whereas 4.1% would do so without capsular violation (P < .001). Most respondents (50.9%) would remove visually significant cataracts within 4 weeks in patients within the amblyogenic age range (P = .02), whereas 63.6% would wait longer outside the amblyogenic range. Preferences for intraocular lens selection, primary posterior capsulotomy, and timing of amblyopia therapy differed.

CONCLUSIONS

Individual management practices regarding pediatric traumatic cataracts vary depending on associated globe injuries and patient age. Trends exist in surgical planning, intraoperative techniques, and visual rehabilitation methods, but no single approach has achieved complete unanimity. Therefore, further investigation into optimal timing and the extent of surgical intervention, refractive correction, and postoperative care is necessary prior to developing evidence-based guidelines for enhancing visual outcomes in this population. [J Pediatr Ophthalmol Strabismus. 2020;57(3):190-198.].

Secondary Sulcus-Fixed Foldable IOL Implantation with 25-G Infusion in Patients with Previous PPV after Open-Globe Injury

PURPOSE

To evaluate the safety and efficacy of secondary sulcus-fixed foldable intraocular lens (IOL) implantation through a clear corneal incision with 25-G infusion in patients with previous pars plana vitrectomy (PPV) after open-globe injury, and to analyze postoperative outcomes and prognostic factors of treatment.

METHODS

Clinical data of 89 eyes of 89 patients with open-globe injury who underwent secondary sulcus-fixed foldable IOL implantation through a clear corneal incision with 25-G infusion after vitrectomy in our hospital between January 2008 and June 2015 were retrospectively analyzed. The examinations before IOL implantation mainly included visual acuity, slit-lamp examination, direct and indirect ophthalmoscope, visual electrophysiology, corneal endothelium, B scan, ultrasound biomicroscope, and intraocular pressure. Five eyes underwent suturing of peripheral iris and 7 eyes underwent suturing of iris laceration simultaneously. The mean follow-up was 18 months with a range from 6 months to 8 years.

RESULTS

The mean interval between secondary sulcus-fixed foldable IOL implantation and vitrectomy was 2.8 months with a range from 2 to 6 months. The uncorrected visual acuity improved in all patients with a well-centered IOL ranging from 0.1 to 0.8 with the best-corrected visual acuity from 0.1 to 1.0 after secondary IOL implantation. The postoperative complications mainly included mild anterior chamber exudates in 10 eyes (11%), temporary IOP elevation in 12 eyes (13%), and recurrent retinal detachment in 5 eyes (6%), which were subsequently managed by surgery.

CONCLUSIONS

The interval of 2.8 months between vitrectomy and secondary IOL implantation is an appropriate and safe option to correct aphakia in patients receiving vitrectomy for open-globe injury.

Comparison of Two Intraocular Lens Implantation Techniques in Pediatric Cataract Surgery in Terms of Postoperative Complications

Background:

Pediatric cataract surgery differs substantially from adult cataract surgery. Numerous studies have focused on reducing the development of postoperative complications.

Aims:

To compare two intraocular lens implantation techniques used in pediatric cataract surgery in terms of postoperative complications.

Study Design:

Case-control study.

Methods:

Patients who underwent pediatric cataract surgery and intraocular lens implantation between 2008 and 2016 were evaluated in this retrospective study. Patients aged 3-15 years with unilateral or bilateral cataract and without corneal pathology were included in the study. The patients were categorized into the following two groups: those who underwent posterior capsulorhexis and anterior vitrectomy using in-the-bag intraocular lens implantation (group 1) and those who underwent posterior capsulorhexis and intraocular lens implantation with the optic fixed behind the posterior capsulorhexis (group 2). Rates of postoperative visual axis opacification and complications (glaucoma, posterior synechiae, uveitic reaction, and intraocular lens decentration) were evaluated in these groups. The implanted intraocular lenses were either monoblock (AcrySof SN60AT intraocular lens), triple-piece (AcrySof MA60BM intraocular lens) foldable hydrophobic acrylic lenses, or multifocal lenses (AcrySof IQ ReSTOR).

Results:

This retrospective study included 52 eyes of 37 patients. Group 1 comprised 26 eyes of 20 patients and group 2 comprised 26 eyes of 17 patients. During the follow-up, visual axis opacification was observed in two patients in group 1 but no patients in group 2. Regarding postoperative complications, there was no uveitic reaction, posterior synechiae, or intraocular lens decentration in either group. There was no significant difference between the groups in terms of the postoperative complications (p>0.05).

Conclusion:

There was no significant difference between in-the-bag intraocular lens implantation after posterior capsulorhexis and intraocular lens optic capture through posterior capsulorhexis in terms of the complications.

Infantile cataract: comparison of two surgical approaches

OBJECTIVE

To compare the results of 2 cataract extraction techniques with primary intraocular lens (IOL) implantation in children.

DESIGN

Retrospective comparative case series study.

METHODS

This study included children with congenital or developmental cataract. In all cases, anterior capsulorhexis, lens aspiration, posterior continuous curvilinear capsulorhexis, and primary IOL implantation were performed. We compared 2 surgical approaches. In the first approach, after IOL implantation in the bag, posterior optic capture (OC) was performed without anterior vitrectomy (OC technique); in the second approach, anterior vitrectomy was performed without OC of the IOL (AV technique). Patient demographic data as well as ethnic origin, child's age at cataract diagnosis, child's age at surgery, axial length, IOL power in diopters, visual acuity, visual axis opacification, and complications were assessed.

RESULTS

One hundred twenty-three eyes were included for surgical approach outcomes comparison; 21 eyes underwent the OC surgical approach and 102 the AV surgical approach. The mean patient age at surgery was 57.3 ± 47.1 months. The mean follow-up was 63.13 months (range 12-202 months). Epithelial lens reproliferation was the major adverse event in our series, affecting 21.1% of patients' eyes; the mean time to epithelial lens reproliferation development was 90 ± 9.70 months. There was no statistically significant difference between the two groups in best spectacle-corrected visual acuity or epithelial lens reproliferation incidence.

CONCLUSIONS

In our case series we did not find any difference between surgical techniques.

A Meta-analysis on the clinical efficacy and safety of optic capture in pediatric cataract surgery

AIM

To evaluate the clinical efficacy and safety of optic capture in pediatric cataract surgery.

METHODS

Searches of peer-reviewed literature were conducted in PubMed, Embase and the Cochrane Library. The search terms were "optic capture" and "cataract". The retrieval period ended in December 2014. Relevant randomized controlled trials (RCTs), case-control studies and cohort studies were included. Meta-analyses were performed. Pooled weighted mean differences and risk ratios with 95% confidence intervals were estimated.

RESULTS

Ten studies involving 282 eyes were included, 5 of which were RCTs involving 194 eyes. The application of optic capture significantly reduced both opacification of the visual axis (RR: 0.12; 95% CI: 0.02 to 0.85; P=0.03) and occurrence of geometric decentration (RR: 0.09; 95% CI: 0.02 to 0.46; P=0.004). But it did not significantly affect best corrected visual acuity (BCVA) (WMD: -0.01; 95%CI: -0.07 to 0.05; P=0.75) and influence the occurrence of posterior synechia (RR: 1.53; 95% CI: 0.84 to 2.77; P=0.17). Deposits in the anterior intraocular lens were significantly increased in the optic capture group early after surgery (RR: 1.40; 95% CI: 1.05 to 1.86; P=0.02) and at the last follow-up (RR: 2.30; 95% CI: 1.08 to 4.92; P=0.03). The quality of the evidence was assessed as high.

CONCLUSION

The application of optic capture significantly reduces opacification of visual axis and occurrence of geometric decentration but do not significantly improve BCVA with notable safety.

Maximizing the visual outcome in traumatic cataract cases: The value of a primary posterior capsulotomy and anterior vitrectomy

Objective:

The objective was to provide evidence-based care for patients with traumatic cataracts, we assessed whether a posterior capsulotomy and anterior vitrectomy, as part of the primary surgical procedure, could be a positive predictor of final visual outcome.

Materials and Methods:

This is a prospective randomized control trial. Patients presenting at our hospital between January 2010 and December 2012 having ocular trauma and traumatic cataracts were enrolled, according to the inclusion criteria. We enrolled two groups: Those with and without primary posterior capsulotomy and vitrectomy. Information regarding demographic and ocular trauma were collected using the World Eye Trauma Registry form at the first visit and follow-up, and specific information was collected for both the group who underwent posterior capsulectomies and vitrectomies as a part of the primary procedure, and the control group. Data were analyzed to evaluate the predictive value of primary posterior capsulectomy and anterior vitrectomy.

Results:

We enrolled 120 cases, 60 in each group, comprising 31 females and 89 males. When all other variables were controlled for, the visual outcome (best corrected visual acuity) differed significantly (P < 0.001) between the groups.

Conclusion:

Performance of posterior capsulectomy and anterior vitrectomy as part of the primary procedure improves the final visual outcome.

Predictors of visual outcome in traumatic cataract

Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.

Controversies in traumatic cataract classification and management: a review

Traumatic cataract is one of the important causes of blindness after ocular trauma, either open or close globe. Visual outcome is unpredictable because it is not only lens that decides visual outcome. There is no standard classification, investigation, or treatment guidelines for the same. There are controversies regarding predictive models. We would like to highlight these controversies and try to reach certain guidelines that may help clinicians to manage traumatic cataracts.

Epidemiology and Intermediate-Term Outcomes of Open- and Closed-Globe Injuries in Traumatic Childhood Cataract

Purpose

To study epidemiology and intermediate-term outcomes of open- and closed-globe injuries (CGI) in traumatic childhood cataract.

Methods

In this retrospective interventional case series, demographic parameters and history including type of injury of 57 children younger than 16 years with traumatic cataract were recorded; ocular examination included best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, and posterior segment evaluation. Patients underwent cataract surgery with or without intraocular lens (IOL) implantation. Main surgical outcomes at 6 months comprised BCVA, residual refractive spherical error (SE), and postoperative complications, namely visual axis opacification (VAO) and amblyopia.

Results

Bow and arrow was the most common causal agent. Open-globe injury (OGI) was 3 times more frequent than CGI. There was a significant visual gain from baseline in both groups after cataract surgery (p<0.001); residual SE was greater in OGI (1.6 ± 0.95 SD) compared to blunt trauma (0.8 ± 0.55 SD; p = 0.001). Incidence of corneal scarring, iris distortion, posterior synechiae, and intraoperative posterior capsular tear was greater with OGI (p<0.05). A total of 86% of patients were rehabilitated with a primary/secondary IOL. Single-piece IOL implantation rate (p = 0.004) was significantly greater in CGI, with no statistical difference for in-the-bag IOL (p = 0.053) and IOL implantation rate (p = 0.16). Final BCVA was significantly better for in-the-bag IOL implantation compared to sulcus fixation. Postoperative complications included amblyopia (51%) and VAO (12%).

Conclusions

Bow and arrow injury caused the maximum cases of traumatic cataract; cataract extraction resulted in significant visual improvement; and CGI tended to have better prognosis in pediatric traumatic cataracts.

Association of height, body weight, age, and corneal diameter with calculated intraocular lens strength of adult horses

OBJECTIVE

To determine whether differences exist in the calculated intraocular lens (IOL) strengths of a population of adult horses and to assess the association between calculated IOL strength and horse height, body weight, and age, and between calculated IOL strength and corneal diameter.

ANIMALS

28 clinically normal adult horses (56 eyes).

PROCEDURES

Axial globe lengths and anterior chamber depths were measured ultrasonographically. Corneal curvatures were determined with a modified photokeratometer and brightness-mode ultrasonographic images. Data were used in the Binkhorst equation to calculate the predicted IOL strength for each eye. The calculated IOL strengths were compared with a repeated-measures ANOVA. Corneal curvature values (photokeratometer vs brightness-mode ultrasonographic images) were compared with a paired t test. Coefficients of determination were used to measure associations.

RESULTS

Calculated IOL strengths (range, 15.4 to 30.1 diopters) differed significantly among horses. There was a significant difference in the corneal curvatures as determined via the 2 methods. Weak associations were found between calculated IOL strength and horse height and between calculated IOL strength and vertical corneal diameter.

CONCLUSIONS AND CLINICAL RELEVANCE

Calculated IOL strength differed significantly among horses. Because only weak associations were detected between calculated IOL strength and horse height and vertical corneal diameter, these factors would not serve as reliable indicators for selection of the IOL strength for a specific horse.

Controversies in ocular trauma classification and management: review

Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide. There are unresolved issues regarding the management of OGIs involving the posterior segment. Timing of vitrectomy has been and will continue to be debated by proponents of early versus delayed intervention. The use of prophylactic cryotherapy and scleral buckle is still practiced differently throughout the world. The role of intravitreal antibiotics in posterior segment trauma in the absence of infection is still debated. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved. In optic neuropathy, the role of intravenous methylprednisolone versus conservative management is always debated and still there are no evidence-based guidelines about the beneficial role of pulse steroid therapy. The role of optic canal decompression in the setting of acute traumatic optic neuropathy is also not conclusive. Orbital and adnexal trauma has been shown to adversely affect the outcome of OGI patients but both lids and orbital injury are not taken as preoperative variables in international ocular trauma classification. The timing of intervention in blow-out fracture is still debated. The pediatric age group, owing to the high risk of amblyopia and intraocular inflammation as well as strong vitreoretinal adhesions, has to be managed by different principles. Although the risk of sympathetic ophthalmia is very rare, it is always one of the key debated issues while managing traumatized eyes with no light perception vision. Prospective, controlled clinical studies are not possible in the OGI setting and this article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.

Effect of penetrating and blunt ocular trauma on the outcome of traumatic cataract in children in northern India

BACKGROUND

We studied the demographic profile and outcome of traumatic cataract after penetrating and blunt ocular trauma in children in northern India.

METHODS

We reviewed the medical records of children with penetrating and blunt ocular trauma associated with traumatic cataract who underwent cataract surgery with posterior chamber intraocular lens implantation and having more than 1 year follow up. We evaluated the demographic characteristics and visual outcome in the affected eye.

RESULTS

Of the 100 children (100 eyes), 65 were penetrating trauma and 35 were blunt trauma. The common modes of injury in the penetrating group were wooden splinters in 30.8% and bow and arrow in 15.4%. Fire crackers and trauma during play with ball were seen in 34% and 11.4% of blunt eye trauma, respectively. The age ranged from 1 to 14 years (mean, 7.8 years) in the penetrating trauma and 2 to 15 years (mean, 8.3 years) in the blunt trauma group. The best corrected visual acuity of 20/40 or better was achieved in 57.6% eyes in penetrating group compared with 71.4% in the blunt trauma group. Visually significant posterior capsular opacification developed in 32.3% eyes in penetrating group and 28.6% eyes in blunt trauma group. Glaucoma was diagnosed in 4.6% eyes in penetrating group and 8.6% in blunt trauma group.

CONCLUSION

Eye injuries with traumatic cataract are associated with significant visual impairment. There were more children with penetrating eye injuries as compared with blunt trauma. Cataract surgery with intraocular lens implantation is a preferred method for visual rehabilitation in these children.

LEVEL OF EVIDENCE

Epidemiologic study, level IV.

A pilot study on the corneal curvatures and ocular dimensions of horses less than one year of age

Intraocular lenses (IOLs) have been implanted in adult equine eyes after cataract surgery. Foals and weanlings comprise a large proportion of those horses undergoing cataract surgery. Due to potential differences in the size and corneal curvature of the juvenile eye, it is not currently known whether implantation of adult IOLs is appropriate in foals and weanlings. The objective of the study was to measure the anterior chamber depth (ACD), central lens thickness (CLT), vitreous chamber depth (VCD), axial globe length (AGL) and corneal curvature of horses less than one year of age. The axial dimensions from one eye of 10 foals were measured using simultaneous A and B scan ultrasonography. The corneal curvature from one eye of 7 weanlings was determined using a modified photokeratometer. Ultrasonography revealed a mean ACD of 4.94 mm, mean CLT of 9.38 mm, mean VCD of 18.96 mm and mean AGL of 33.32 mm for the foals. The mean corneal curvature was 15.4 diopters (D). The mean ACD, CLT, VCD and AGL of the foals were less than the measurements reported in the literature for adult horses. The mean corneal curvature was similar to the values reported by some authors for adult horses. Due to the differences in axial dimensions between adult and juvenile eyes, an IOL that corrects vision in an adult horse might not adequately correct vision in a horse less than one year of age.

Outcome of in-the-bag implanted square-edge polymethyl methacrylate intraocular lenses with and without primary posterior capsulotomy in pediatric traumatic cataract

Purpose:

To study the outcome of in-the-bag implanted square-edge polymethyl methacrylate (PMMA) intraocular lenses (IOL) with and without primary posterior capsulotomy in pediatric traumatic cataract.

Materials and Methods:

The study was undertaken in a tertiary care center. Thirty eyes of 30 children ranging in age from 4 to 16 years with traumatic cataract which underwent cataract extraction with capsular bag implantation of IOL were prospectively evaluated. Group A included 15 eyes of 15 children where primary posterior capsulotomy (PPC) and anterior vitrectomy with capsular bag implantation of square-edge PMMA IOL (Aurolab SQ3602, Madurai, Tamil Nadu, India) was performed. Group B comprised 15 eyes of 15 children in which the posterior capsule was left intact. Postoperative visual acuity, visual axis opacification (VAO) and possible complications were analyzed.

Results:

Best corrected visual acuity (BCVA) of 20/40 or better was achieved in 12 of 15 eyes in both groups. Amblyopia was the cause of no improvement in visual acuity in the remaining eyes. Visual axis opacification was significantly high in Group B as compared to Group A (P=0.001). Postoperative fibrinous uveitis occurred in most of the eyes in both groups. Pupillary capture was observed in one eye in each group.

Conclusion:

Primary posterior capsulotomy and anterior vitrectomy with capsular bag implantation of square-edge PMMA significantly helps to maintain a clear visual axis in children with traumatic cataract.

Cataract surgery in the setting of trauma

PURPOSE

To review the changes in the surgical techniques used for cataract removal in the setting of trauma and their postoperative outcome.

RECENT FINDINGS

Primary cataract removal with intraocular lens (IOL) implantation is the commonly followed procedure for penetrating injuries with cataract. IOL implantation has evolved through various techniques namely 'in the bag', 'in the sulcus', epilenticular implantation, anterior chamber IOL, scleral fixated IOL and recently glued IOL.

SUMMARY

Certain lacerating injuries of the anterior segment are particularly amenable to cataract extraction and IOL implantation at the time of primary laceration repair. This approach obviates additional operative and anesthetic risks, while affording timelier visual rehabilitation. Secondary lens removal may also be indicated in cases of severe corneal injury and marked edema, which may interfere with intraocular visualization.

Completion rate of primary posterior continuous curvilinear capsulorhexis and vitreous disturbance during congenital cataract surgery

PURPOSE

We sought to document the completion rate of primary posterior continuous curvilinear capsulorhexis during congenital cataract surgery and determine the incidence of disruption of vitreous face during this procedure.

METHODS

One hundred six consecutive eyes of patients undergoing posterior continuous curvilinear capsulorhexis (PCCC) during congenital cataract surgery were evaluated prospectively for completion of PCCC and disruption of vitreous face. PCCC was performed under high-viscosity sodium hyaluronate (Healon GV 1.4%) initiated with 26 g of cystotome and later completed with Kraff-Uttrata forceps by frequent grasping and regrasping of the flap. Completion of PCCC and disruption of vitreous face during the procedure was noted. Even in cases of disrupted vitreous face, PCCC was performed and completed with forceps and, later, disruption of vitreous face was managed with 2-port automated limbal anterior vitrectomy. The size of PCCC was measured. An Alcon AcrySof SA30AL was implanted in-the-bag if the PCCC was 4 mm or smaller and in the sulcus when the PCCC was larger than 4 mm.

RESULTS

The mean age of the 106 pediatric patients was 17 +/- 26 months (median, 6 months; range, 1 month to 8 years). PCCC was completed in all the eyes. Disruption of vitreous face during PCCC was noted in 5 of 106 (4.7%) eyes. The mean size of PCCC was 3.6 +/- 0.7 mm. A total of 98 (92.5%) had in-the-bag, and 8 (7.5%) eyes had sulcus implantation of IOL.

CONCLUSION

PCCC was completed in all eyes with minimal disruption of vitreous face in a well-controlled manner under high-viscosity viscoelastics.

The effectiveness of Nd:YAG laser capsulotomy for the treatment of posterior capsule opacification in children with acrylic intraocular lenses

INTRODUCTION

Acrylic intraolcular lenses (IOLs) may result in lower rates of posterior capsular opacification (PCO) than poly(methyl methacrylate) lenses in children. Nonetheless, PCO frequently occurs eventually, especially in younger children. Here, we evaluated the success of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy for the management of PCO after acrylic IOL implantation without primary capsulectomy.

METHODS

We reviewed 73 eyes in 57 children (age 23 months to 12 years; median, 6.4 years) who underwent Nd:YAG laser capsulotomy after AcrySof IOL implantation and who had at least 3 months follow-up (range, 3-92 months; median, 25 months). The effectiveness of laser treatment was evaluated in terms of the need for repeat laser procedures or intraocular surgery to clear the visual axis.

RESULTS

Fifty-one eyes (70%) maintained a clear visual axis after a single Nd:YAG procedure, 10 eyes (84% cumulative) after 2 Nd:YAG procedures, and another 3 eyes (88% cumulative) after 3 Nd:YAG procedures. Six eyes (8%) required pars plana membrane removal to clear the visual axis, whereas 3 eyes (4%) continue to need treatment. Life table analysis showed that the probability of continuing success after 24 months with a single Nd:YAG procedure is 68% (95% confidence interval 53-83%). In younger children (age<4 years), this rate probability was lower than in older children (35% vs. 74%; P=0.022). Two eyes developed mild transient elevated intraocular pressure. In 1 eye, the IOL was dislocated and replaced.

DISCUSSION

Nd:YAG laser capsulotomy is an acceptable option for the management of PCO after AcrySof IOL implantation in children and produces complications infrequently.

Strabismus in pediatric pseudophakia

OBJECTIVE

To evaluate strabismus associated with pediatric pseudophakia.

DESIGN

Retrospective case series.

PARTICIPANTS

Charts of 94 pediatric patients who underwent cataract extraction with primary intraocular lens implantation from 1990 to 2003 at Indiana University School of Medicine were reviewed. Only those patients who had pre-cataract extraction and post-cataract extraction alignment measurements were included.

METHODS

Data were collected on gender, race, age at presentation, age at time of cataract surgery, and type of cataract. Pre-cataract extraction and post-cataract extraction data on visual acuity (VA), alignment, and amblyopia were recorded. Results of strabismus surgery were also evaluated.

MAIN OUTCOME MEASURES

Frequency, type and amount of strabismus, and results of strabismus surgery.

RESULTS

Ninety-four pediatric pseudophakia patients were identified, and 37 (39%) had strabismus. Exotropia (46%) was more common than esotropia (41%). Factors not associated with the development of strabismus included age at presentation, interval between diagnosis and cataract extraction, race, and type of cataract. Factors statistically associated with the development of strabismus include pre-cataract extraction and post-cataract extraction VA, type of strabismus, and post-cataract extraction amblyopia. The mean pre-cataract extraction deviation of the group that had strabismus surgery was 22 prism diopters, and 75% were aligned at the last examination (mean follow up, 24 months).

CONCLUSION

Strabismus occurs more frequently in pseudophakic pediatric patients than in the general pediatric population. Pseudophakic children should be monitored carefully for the development of strabismus, which in many cases can be successfully treated.

Posterior vertical capsulotomy with optic entrapment of the intraocular lens in congenital cataracts--prevention of capsule opacification

PURPOSE

To present a modified surgical technique for preventing posterior capsule opacification (PCO) in children with congenital cataracts and to evaluate its long-term efficacy.

SETTING

Department of Ophthalmology, Medical University of Southern Africa, Medunsa, South Africa.

METHODS

Anterior and posterior vertical capsulotomy, with optic entrapment of the intraocular lens (IOL) by maintaining the anterior hyaloid, was performed in 68 cataractous eyes of children aged 2 months to 8 years (mean 3 years, 1 month). The posterior capsule was evaluated for at least 5 years for secondary opacification, IOL position, pigmentary deposits on the IOL optic, and the presence of synechias.

RESULTS

Sixty-eight eyes maintained a clear visual axis for 5 to 12 years (mean 9 years, 1 month) postoperatively. No secondary procedure was necessary. In all eyes, the IOL remained well centered and entrapped.

CONCLUSIONS

Posterior capsulotomy with optic entrapment of the IOL proved to be a safe and efficient surgical procedure for preventing PCO in children with congenital cataracts. Uniting the anterior and posterior capsule in front of the IOL limits the proliferation and migration of Elschnig pearls. An intact anterior hyaloid does not induce capsule opacification in association with optic entrapment; therefore, a vitrectomy is not indicated even in infants under age 5 years. Clear visual axis, centered IOL, and intact vitreous were achieved in this series; this enables a promising long-term prognosis for binocular visual development, especially because surgery was performed early.

Combined intraocular lens implantation and glaucoma implant (tube shunt) surgery in pediatric patients: a case series

PURPOSE

We sought to investigate the outcomes of children who underwent simultaneous intraocular lens (IOL) implant and glaucoma implant surgery.

METHODS

Medical records of all patients who underwent simultaneous IOL implant and glaucoma implant surgery from January 1995 through August 2003 by a single surgeon were reviewed. Criteria for success included intraocular pressure </=22 mm Hg, or judged adequate for glaucoma severity, without vision loss or devastating complication.

RESULTS

The study included 9 eyes of 8 children who had a mean age of 7.6 years (range, 1-16) and a mean follow-up time of 21 months (range, 8.5-35 months) after simultaneous IOL (either cataract removal with primary IOL, 2 eyes; or secondary IOL implantation, 7 eyes), and glaucoma implant surgery (6 Baerveldt, 3 Ahmed). The indications for combined surgery fell into 3 basic categories: unilateral aphakia with glaucoma (4/9), anatomical features (such as shallow anterior chamber and/or vitreous in the pupillary plane) making an IOL helpful in positioning the tube away from corneal endothelium and/or vitreous (4/9), and unilateral traumatic cataract (1/9). Mean intraocular pressure for operated eyes was 29 mm Hg (range, 21-44) preoperatively and fell to 17 mm Hg (range, 11-22) at last follow up, P = 0.01. The mean number of glaucoma medications was 3.5 preoperatively (range, 2-5) versus 1.9 (range, 0-4) at last follow-up (p = NS). Complications (n = 5) were varied, only 2 of which required additional surgery. Eighty-nine percent (8/9) of patients met criteria for success at last follow-up.

CONCLUSIONS

Selected children can do well after combined glaucoma implant and IOL surgery, achieving both satisfactory glaucoma control and stable visual acuity.

Management of the anterior and posterior lens capsules and vitreous in pediatric cataract surgery

PURPOSE

To review and discuss the advantages and disadvantages of various methods of managing anterior and posterior lens capsules and anterior vitreous in pediatric cataract surgery.

METHODS

We reviewed the literature related to pediatric cataract surgery on PubMed and subclassified the subject into subtopics for managing the anterior lens capsule, posterior lens capsule, and anterior vitreous.

RESULTS

After a review of the literature, we summarized the advantages and disadvantages of various approaches related to surgical managements of the anterior lens capsule, posterior lens capsule, and anterior vitreous in pediatric cataract surgery. We discussed recommendations from the literature and commented on our experiences related to the above subtopics.

CONCLUSION

In the surgical management of pediatric cataract, anterior continuous curvilinear capsulorhexis provides the most reliable and tear-resistant capsular opening. Vitrectorhexis and radiofrequency diathermy, on the other hand, are alternative approaches (depending on the surgeon's personal preference). Primary posterior continuous curvilinear capsulorhexis may delay the onset of posterior capsule opacification. Anterior vitrectomy may be necessary to prevent or eliminate the onset of posterior capsule opacification in young children.

Management of paediatric traumatic cataract by epilenticular intraocular lens implantation: long-term visual results and postoperative complications

PURPOSE

This study was carried out to evaluate the postoperative visual results and complications following epilenticular intraocular lens implantation in paediatric traumatic cataracts.

MATERIALS AND METHODS

A total of 30 patients undergoing epilenticular intraocular lens implantation for traumatic pediatric cataract were evaluated prospectively for visual results and complications. After-cataract formation was the prime area of interest. Follow-up of patients ranged from 2 to 8 years (mean 5 years). In all, 90% of eyes had a visual acuity of 6/60 or worse at the time of presentation.

RESULTS

In total, 80% of our patients achieved a visual acuity of 6/12 or better postoperatively after a mean follow-up of 5 years. None of our patients had after-cataract formation and the visual axis remained clear until the last follow-up in all the patients.

CONCLUSION

Epilenticular intraocular lens implantation in paediatric traumatic cataracts is associated with favourable anatomic and visual results.

Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery

PURPOSE

To study the effect of primary posterior capsulotomy with anterior vitrectomy (PPC + AV) and intraocular lens (IOL) design and material on the development of posterior capsule opacification (PCO) after pediatric cataract surgery.

SETTING

Tertiary care institution in India.

PATIENTS

Sixty-four eyes of 52 children ranging in age from 3 months to 12 years who had cataract extraction with IOL implantation were prospectively evaluated for a minimum postoperative period of 2 years.

METHODS

Thirty-two eyes received a hydrophobic acrylic lens with a truncated, square edge and 32, a single-piece poly(methyl methacrylate) (PMMA) lens that was not heparin surface modified. Sixteen eyes in each IOL group had PPC + AV; in the remaining 16 eyes in each group, the posterior capsule was left intact.

RESULTS

Postoperatively, 25 eyes in the intact capsule group and 5 in the PPC + AV group developed PCO; the difference between groups was significant (P<.05). Of eyes with an intact capsule, 12 with an acrylic IOL and 13 with a PMMA IOL developed PCO (P>.05). In the PPC + AV group, 2 eyes with an acrylic IOL and 3 with a PMMA IOL developed PCO (P>.05). Overall, 14 eyes with an acrylic lens and 16 eyes with a PMMA lens developed PCO (P>.05). After surgery, there was a significant short-term delay in the development of PCO in the acrylic group (14 eyes; mean 6.66 months +/- 1.57 [SD]) compared to the PMMA group (16 eyes; mean 3.16 +/- 0.83 months) (P<.05).

CONCLUSIONS

It is the management of the posterior capsule rather than IOL design and material that influences the incidence of PCO after cataract surgery in children. Development of PCO in the postoperative period was delayed with a hydrophobic acrylic IOL with square edges compared with a PMMA lens without square edges.

Prospective analysis of pediatric pseudophakia: myopic shift and postoperative outcomes

PURPOSE

Limited data exist about long-term refractive changes in eyes of children with intraocular lens (IOL) implantation. Information of postoperative results should allow more accurate predictions for IOL power implantation in children. Data regarding IOL complications, including secondary membranes, myopic shift, stereopsis, and pseudophakic glaucoma should also be reported.

METHODS

In a prospective study, the refractive errors of all pediatric patients between 12 months and 18 years who had cataract surgery and IOL implantation were evaluated at 4 weeks, 3 months, 6 months, 1 year, and every 6 months thereafter. All patients were followed for a minimum of 3 years.

RESULTS

Fifty-two eyes of 42 patients met inclusion criteria. Forty-two eyes had developmental cataracts. There were 10 bilateral cases. Of the 52 eyes, 85% had 20/40 vision or better. Visual acuity of 20/30 or better was achieved in 95% of bilateral eyes. In unilateral cataracts, visual acuity was 20/50 or better in 74% of eyes. Mean follow-up time was 5.45 years with a range of 3 to 10.5 years. Mean follow-up by age group ranged between 4.38 and 6.35 years. Children operated on at 12 months to 2 years of age had a mean myopic shift of -5.96 D; children operated on at 3 and 4 years of age had a -3.66 D shift; children operated on at 5 and 6 years of age had a shift of -3.40 D; children operated on at 7 and 8 years of age had a shift of -2.03 D; children operated on at 9 and 10 years of age had a mean shift of -1.88 D; children operated on at 11 to 14 years of age had a shift of -0.97 D; children operated on at 15 to 18 years of age had -0.38 D shift. No cases of pediatric pseudophakic glaucoma were observed. Secondary membrane occurred in 72% of eyes when the capsule was left intact. The operated eye showed a greater mean myopic shift than the nonoperated eye. No statistically significant difference in refractive change was found comparing amblyopic to nonamblyopic eyes or traumatic to nontraumatic cataracts.

CONCLUSIONS

The greatest rate of refractive growth or change occurred between 1 and 3 years of age. After age 3 years, the rate of refractive growth followed a more linear trend. Based on this study, we have provided a guide for selecting IOL power in pediatric cataract cases using current formulas with the understanding that new formulas will need to be devised to better predict IOL power in children.

Posterior continuous curvilinear capsulorhexis with and without optic capture of the posterior chamber intraocular lens in the absence of vitrectomy

PURPOSE

To evaluate the efficacy of posterior continuous curvilinear capsulorhexis (PCCC) with optic capture of the posterior chamber intraocular lens (PC IOL) in the absence of vitrectomy in preventing secondary opacification of the visual axis following pediatric cataract surgery.

PATIENTS AND METHODS

Thirty-four eyes of 28 children with congenital or developmental cataract, aged 1.5 to 12 years (mean, 6.39 years), were included in this prospective, randomized study. Anterior continuous curvilinear capsulorhexis (ACCC) with PCCC without optic capture of the PC IOL was performed in group A (18 eyes) and ACCC with PCCC with optic capture of the PC IOL was performed in group B (16 eyes). None of the eyes underwent anterior vitrectomy. Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed.

RESULTS

The follow-up period ranged from 8 to 28 months (mean, 17.5 months). All 16 eyes (100%) in group B had a clear visual axis at the end of follow-up. Eight eyes (44.4%) in group A had significant opacification of the visual axis. The difference between the two groups was statistically significant (P = .0011). No eye in group B required secondary intervention, whereas all 8 eyes in group A with significant secondary opacification required secondary intervention. There was no statistically significant difference in other complications such as anterior chamber reaction, fibrin formation, lenticular precipitates, and posterior synechiae. The final best-corrected visual acuity at the end of follow-up was comparable in the two groups (P > .05).

CONCLUSION

PCCC with optic capture of the PC IOL prevents secondary opacification of the visual axis even in the absence of vitrectomy.

Long-term rates of PCO following small incision foldable acrylic intraocular lens implantation in children

PURPOSE

To evaluate the long-term incidence of postoperative posterior capsular opacification (PCO) in children undergoing small incision foldable acrylic lens implantation with at least 2 years of follow up.

METHODS

In 18 children, 26 eyes underwent small incision cataract extraction with posterior chamber foldable acrylic lens implantation. The posterior capsule was left intact in all patients at the time of surgery.

RESULTS

With a mean follow up of 2.75 years and a mean age at surgery of 8.25 years, 13 of 26 eyes (50%) developed visually significant PCO requiring intervention. In the group of children under 4 years of age, 5 of 5 eyes (100%) developed visually significant PCO, while 8 of 21 eyes (38%) in the group of children over 4 years of age developed opacification. Four of 26 eyes (15%) required two procedures (either repeat Nd:YAG laser capsulotomy or pars plana secondary membrane removal) to clear the visual axis.

CONCLUSION

In this study, the incidence of PCO following small incision acrylic lens implantation in children over 4 years of age is lower than those rates reported by conventional large incision rigid lens techniques with a minimum of 2 years follow up. This technique has advantages over conventional techniques in older children because it offers less surgical intervention, a lower cost to patients, and less risk of vitreous and retinal complications.

When may the posterior capsule be preserved in pediatric intraocular lens surgery?

PURPOSE

To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamber intraocular lens (PCIOL) implantation for cataract in childhood.

DESIGN

Noncomparative case series.

PARTICIPANTS

Patients 1 to 13 years old who underwent cataract extraction with intent to preserve the posterior lens capsule and PCIOL implantation between January 1992 and December 1998 at a pediatric hospital.

METHODS

Medical records were reviewed to determine the frequency and timing of posterior capsule opacification (PCO) after PCIOL surgery with preservation of an intact posterior capsule. Comparison of pseudophakic PCO rates for groups defined by age and several possible risk factors. Assessment of safety and efficacy for PPC with anterior vitrectomy performed through a limbal incision in cases where the posterior capsule could not be preserved.

MAIN OUTCOME MEASURES

Need for neodymium:yttrium-aluminum-garnet laser capsulotomy or surgical membranectomy to treat PCO.

RESULTS

PCO occurred in 40% of 30 eyes with intact posterior capsule. Mean follow-up duration was 22 months for eyes that had PCO develop and 24 months for those in which the posterior capsule remained clear. Laser capsulotomy was required for 64% of 14 eyes in the 1- to 6-year-old age range but for only 19% of 16 in the 6- to 13-year-old range (P < 0.05). Mean time from surgery to PCO was 7 months for the younger group and 13 months for the older group. A need for repeated capsulotomy (one eye) or membranectomy with anterior vitrectomy (two eyes) was found only in the younger age group. There was no association of PCO with trauma history, cataract type, residual lens cortex, IOL position, or postoperative fibrin clot. Final vision was possibly compromised as a result of PCO in one eye with amblyopia. None of 24 eyes in which PPC with anterior vitrectomy was performed out of intraoperative necessity before primary PCIOL implantation had secondary opacification develop. No reduction in postoperative vision was attributable to PPC.

CONCLUSIONS

PPC seems to be advisable for children less than 6 years old when cataract extraction with PCIOL implantation is performed. Preservation of the posterior capsule remains appropriate for older children with pseudophakia.

Intraocular lens implantation for traumatic cataract in children in East Africa

PURPOSE

To review the visual outcomes and complications after intraocular lens (IOL) implantation in children with traumatic cataract in sub-Saharan Africa, where contact lenses for unilateral aphakia are impractical in most patients.

SETTING

PCEA Kikuyu Eye Unit, Nairobi, Kenya, East Africa.

METHODS

All children younger than 16 years having IOL implantation for traumatic cataract between February 1993 and December 1998 (215 eyes) were retrospectively reviewed. Complications and visual outcomes were evaluated.

RESULTS

The study group comprised 147 boys and 68 girls. The median interval between injury and cataract surgery was 8 weeks. The most common causes of injury were stick (36.3%) and thorn (10.7%). Extracapsular cataract extraction with IOL implantation was performed in all patients. The most frequent early complication was fibrinous uveitis in 110 eyes (51.2%). One hundred sixty-seven eyes (77.7%) had 1 month or more follow-up. Of those, 108 eyes (64.7%) had a best corrected visual acuity of 20/60 or better. Twenty-one eyes (12.6%) had a visual acuity of worse than 20/200, with the most common causes being amblyopia (9/21) and retinal detachment (5/21). Amblyopia was found in 42 of 108 (38.9%) children aged 8 years or less at the time of injury. Eyes with the IOL in the capsular bag were significantly less likely to require subsequent capsulotomy (P <.01) during the 2-year follow-up.

CONCLUSION

The results indicate that posterior chamber IOLs can be safely implanted by experienced surgeons in most children older than 2 years with traumatic cataract and should be the standard of care throughout the world.

Optic capture of the AcrySof intraocular lens in pediatric cataract surgery

PURPOSE

To assess the results of acrylic intraocular lens (IOL) optic capture in children with cataract.

SETTING

Department of Ophthalmology, Hospital de Clínicas José de San Martín, and Instituto de la Vision, School of Medicine, University of Buenos Aires, Argentina.

METHODS

Eight children had cataract surgery. After lens and cortex aspiration, an AcrySof (Alcon) IOL was implanted in the bag. A primary posterior capsulorhexis was performed. The optic edges were slipped through the posterior capsule leaflets. Clarity of the visual axis, preoperative and postoperative best corrected visual acuities (BCVAs), and refraction were evaluated.

RESULTS

The visual axis remained clear in all cases. No case required a secondary procedure. The mean preoperative BCVA was 0.06 +/- 0.06 (SD). Postoperatively, the mean BCVA was 0.88 +/- 0.11 and the mean spherical equivalent, +0.62 +/- 1.31. The mean follow-up was 28.9 +/- 5.3 months.

CONCLUSION

Results show that the optic of an acrylic IOL may be captured through a posterior capsulorhexis in pediatric cataract surgery, combining the advantages of optic capture with a smaller incision and a decreased inflammatory response.

Pediatric secondary lens implantation in the absence of capsular support

PURPOSE

To describe and evaluate alternate techniques for implanting intraocular lenses in children in the absence of adequate capsular support for traditional lens implantation.

METHODS

Postoperative results of 18 eyes with posterior chamber intraocular lenses (PCIOLs) sutured to the ciliary sulcus and 10 eyes implanted with anterior chamber intraocular lenses (ACIOLs) were reviewed. Visual outcomes were divided into 2 groups: onset of aphakia during the critical period of visual development (< or = 9 years) and onset after the critical period (> 9 years). Visual outcomes and complications were recorded.

RESULTS

Average follow-up was 10.3 months in the PCIOL group and 49.2 months in the ACIOL group. Eyes that became aphakic after the critical period of visual development achieved better overall final visual acuity than the eyes that became aphakic during the critical period; indeed, the eyes that became aphakic during the critical period did not achieve significantly improved vision. There were no complications in the PCIOL group. Complications in the ACIOL group included corectopia, haptic migration through the operative wound requiring removal, and pigment deposits on the lens.

CONCLUSIONS

PCIOLs sutured to the ciliary sulcus offer a superior option to ACIOLs for correction of childhood aphakia in children lacking capsular support. ACIOLs had a high rate of serious complications (10%) in this small series. Secondary implantation with transsclerally sutured PCIOLs should be considered in complicated cases when more conservative options have been exhausted.

Visual recovery in unilateral traumatic pediatric cataracts treated with posterior chamber intraocular lens and anterior vitrectomy in Pakistan

PURPOSE

To evaluate visual recovery in unilateral traumatic cataracts in children treated with posterior chamber intraocular lens implantation and anterior vitrectomy.

METHODS

Sixteen children with unilateral traumatic cataract between ages 3-10 years (mean, 5 years 8 months) were treated with posterior chamber intraocular lens implantation and anterior vitrectomy. Surgery was performed between 2 weeks and 7 months (mean, 7.75 weeks) after injury. Follow up was between 9 and 29 months (mean, 17.9 months).

RESULTS

The most common postoperative complication was fibrinous uveitis, which developed in 4 children (25%). All eyes had a clear visual axis postoperatively; none required capsulotomy. The mean postoperative refraction was +0.9 diopters (range, +3.50 to -2.75 diopters). Three eyes (18.75%) had visual acuity of 6/9, 8 eyes (50%) had visual acuity of 6/12 or better, and 11 eyes (68.75%) had visual acuity of 6/18 or better. The cause of poor visual acuity was cystoid macular edema in one eye, macular scars in two eyes, and amblyopia in one eye.

CONCLUSIONS

Unilateral traumatic cataracts in children in whom aphakia is corrected with posterior chamber lens implantation combined with anterior vitrectomy result in good visual outcome, and we recommend this treatment modality in traumatic cataract in children.

Visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses in children with traumatic cataracts

PURPOSE

To evaluate the visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses (IOLs) for traumatic cataracts in children.

SETTING

Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

METHODS

Twenty children (20 eyes) with traumatic cataracts had extracapsular cataract extraction (ECCE) and posterior chamber IOL implantation. They were randomly divided into 2 groups. Capsular bag fixation was performed in 10 children (Group A) and ciliary sulcus fixation in the other 10 (Group B). Traumatic cataracts associated with large corneal lacerations (10.0 mm or more), hyphema, angle recession, or posterior segment involvement were excluded. The best corrected visual acuity (BCVA) as well as early and delayed postoperative complications were prospectively evaluated in both groups.

RESULTS

The BCVA was 6/12 or better in 9 eyes (90%) in Group A and 8 eyes (80%) in Group B at the end of the mean follow-up (24.6 months +/- 10.6 [SD]). Amblyopia (1 eye in Group A) and corneal scar and commotio retinae (1 eye each in Group B) accounted for a visual acuity of worse than 6/12. The residual refractive error did not exceed 3.50 diopters in either group. The incidences of fibrinous anterior uveitis and pupillary capture were significantly higher in Group B (P < .05, Fisher exact test).

CONCLUSION

Capsular bag fixation of posterior chamber IOLs provided visual results similar to those with ciliary sulcus fixation but was associated with fewer postoperative complications, particularly uveitis and pupillary capture. This represents another important reason to attempt in-the-bag fixation in cases of traumatic cataract.

Stereopsis after primary in-the-bag posterior chamber implantation in children

PURPOSE

The purpose of this study was to evaluate visual acuity and binocular function after primary posterior chamber intraocular lens (IOL) implantation in children.

PATIENTS AND METHODS

A retrospective chart review of 39 eyes of 31 children was performed. Fifteen eyes with traumatic, 17 with developmental, and 7 with congenital cataracts without any other ophthalmologic problems were examined before and after cataract surgery (irrigation/aspiration procedure with implantation of a posterior chamber IOL). Twelve eyes also received a posterior capsulorrhexis and anterior vitrectomy. The mean age at surgery was 6.9 +/- 3 years (range, 3-12 years).

RESULTS

Twenty (51%) of 39 eyes achieved a best-corrected postoperative visual acuity of 20/40 or better (range, 20/200-20/20). The mean postoperative visual acuity was 20/40 in the traumatic and developmental cataract groups and 20/100 in the congenital cataract group. There was a positive correlation between cataract morphology and visual acuity (P<.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (P <.005). Nineteen (70%) of 27 eyes in which no primary posterior capsulorrhexis had been performed had posterior capsule opacification. Stereopsis was found in 10 of the 31 patients: 43% of the traumatic cataract group, 30% of the developmental cataract group, and 14% of the congenital cataract group.

CONCLUSIONS

After capsular bag-fixated IOL, visual acuity and binocular function in children older than 3 years were favorable and the complication rate, excluding posterior capsule opacification, was low.

Surgical technique, visual outcome, and complications of pediatric intraocular lens implantation

PURPOSE

To evaluate retrospectively the surgical technique, visual outcome, and complications of pediatric cataract extraction (CE) and intraocular lens (IOL) implantation.

METHODS

Forty-three patients ages 2 to 12 underwent CE with IOL implantation with a minimum follow up of 1 month.

RESULTS

All IOLs were implanted in the posterior chamber with 17 (40%) in the bag, 25 (58%) sulcus fixated, and one (2%) partially in the bag (one haptic in the bag, one in the sulcus). Primary posterior capsulectomy was performed in 12 (28%) cases. A final visual acuity of at least 20/40 was achieved in 26 (60%) and at least 20/80 in 32 (74%). Posterior capsule opacification developed in 18 (42%) and pupillary capture in 7 (16%). Seventeen (40%) patients had postoperative visual acuity worse than 20/40. Of these, nine (53%) had this visual outcome as a result of presumed amblyopia.

CONCLUSIONS

Posterior chamber IOL implantation affords a safe and effective method of visual rehabilitation for cataractous children 2 years of age and older. Amblyopia and antecedent posterior segment trauma, rather than IOL-related or surgical complications, are the limiting factors in final visual outcome.

Visual outcome after paediatric cataract surgery: is age a major factor?

AIMS

To determine functional results after unilateral and bilateral cataract surgery in children with different aphakic optical correction.

METHODS

In this retrospective study, we evaluated visual acuity and binocular vision in 107 children who underwent cataract surgery during the 10 year period from 1985 to 1995. Aphakia was corrected by an intracapsular intraocular lens (IOL), spectacles or contact lenses.

RESULTS

Mean visual acuity was > 20/40 (< 0.3 log MAR) with normal binocular vision in 58 children over 7 months of age operated on for bilateral cataracts. Pseudophakic eyes regained visual acuity > 20/63 (< 0.5 log MAR) more often (90%) than aphakic eyes (46%) (p < 0.001). Binocular vision was also achieved more often after IOL implantation (p < 0.001). Visual outcome of early bilateral cataracts was less satisfactory in children with abnormal foveolar function. For 49 children who had surgery for unilateral cataracts, prognosis was poor when surgery was performed before the age of 7 months. For cataract surgery in older children (> or = 7 months) mean visual acuities were better with IOL implantation (p < 0.05).

CONCLUSION

Cataract surgery with unilateral and bilateral IOL implantation can provide a beneficial effect on final visual outcome in children who are operated on before abnormal foveolar function develops.

Use of intraocular lenses in children with traumatic cataract in south India

AIMS

To assess the long term results of intraocular lens (IOL) implantation for traumatic cataract in young children in a developing country.

METHODS

Prospective hospital based study of 52 children (age 2-10 years) undergoing unilateral cataract extraction and IOL insertion for traumatic cataract performed by a single surgeon in south India. Children were reviewed regularly and followed up initially for 3 years.

RESULTS

There were no serious operative complications. Clinically significant posterior capsule opacification was almost universal (92%) and YAG capsulotomy or membranectomy was performed on 48 eyes. Some degree of pupil capture affected 35% of eyes and was complete in 6%. Visual acuity was 6/12 or better in 67% of eyes at the last follow up examination.

CONCLUSION

The visual acuity results 3 years after implantation of posterior chamber IOLs in older children with traumatic cataracts in south India were encouraging. In developing countries where follow up is unreliable it is essential to plan to clear the axial part of the posterior capsule either at the time of surgery or soon afterwards.

STUDY OF TRAUMATIC CATARACT IN OCCUPATIONAL AND ENVIRONMENTAL TRAUMA AND ITS MANAGEMENT

Sixty cases of traumatic cataract in 5 years due to occupational and environmental hazards were studied to highlight mode of trauma, structural damage; management profile and final visual outcome. Thirty six (60%) cases had mechanical trauma whereas 18 (30%) cases had injuries due to non metalic or organic substances. Industrial accidents were responsible in 25 (41.66%) cases. Forty four cases (73.3%) had associated anterior segment injuries. Reconstruction of anterior segment with Posterior Chamber Intraocular lens (PC IOL) implantation could be done in 42 (70%) cases as primary or secondary procedure. Adherent leucoma, iridal trauma, posterior capsular tear and dislocated lens were noted problems. Forty six (76.67%) cases had attained 6/12 or better corrected visual acuity. Defective visual gain was due to corneal opacities and post operative complications.

Myopic shift after intraocular lens implantation during childhood

PURPOSE

The purpose of the study is to evaluate the myopic shift that occurs in children 3 to 9 years of age who undergo cataract extraction with primary intraocular lens (IOL) implantation.

METHODS

A review of 18 children (mean, 6.3 +/- 0.5 year; range, 3-9 years) who had undergone primary IOL implantation was undertaken. Patients were observed for an average of 3.2 years. The initial and last postoperative refractive errors were compared.

RESULTS

The mean myopic shift was -0.99 +/- 0.22 diopter (D) (median, 1.0 D) with a range of -3.25 to +0.38 D. The difference in the myopic shift of the children 3 to 5 years of age (-0.94 +/- 0.30 D) was not significantly different from the myopic shift occurring in the children 6 to 9 years of age (-1.07 +/- 0.35 D). The myopic shift was less than 1.5 D in 70% of the eyes and only 3 eyes had a myopic shift greater than 2 D. Ninety percent of the children achieved a visual acuity of 20/40 or better in their pseudophakic eye or eyes.

CONCLUSIONS

Although each patient should be evaluated on an individual basis, the authors recommend undercorrecting most children 3 to 9 years of age by 1 D from the IOL power predicted to achieve emmetropia.