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

Intraocular lens-blocking technique for intraocular foreign body removal

The aim of this study was to describe a novel technique for intraocular foreign body (IOFB) removal. Phacoemulsification was performed in all patients, followed by a complete microincision vitrectomy to free all tissues surrounding the IOFB. A three-piece intraocular lens (IOL) was placed in the capsular bag, and an opening was made in the upper center of the capsule. The IOFB was removed and lifted to the anterior chamber through the capsular opening and IOL edge. The IOFB was confined to the anterior chamber by the IOL, and then easily extracted through the main corneal incision. The technique was adopted in six eyes of six patients. All IOFBs were removed successfully in all patients without intraoperative or postoperative complications. The IOL-blocking technique is a useful approach for IOFB removal.

Characterization of postoperative "fibrin web" formation after canine cataract surgery

PURPOSE

To describe the occurrence and associated factors for "fibrin web" (FW) formation following phacoemulsification in dogs.

METHODS

A retrospective review of medical records of all dogs undergoing phacoemulsification (MU-Veterinary Health Center, 2014-2018) was conducted to associate FW formation with signalment, systemic co-morbidities, cataract stage, surgeon (resident vs faculty), phacoemulsification time, IOL, and intracameral injections including viscoelastic type. Both univariate and multivariate statistical analyses were performed to evaluate associations among variables with FW formation.

RESULTS

Data from 398 eyes on 201 dogs were included; 4 left eyes (4 dogs) developed presumptive endophthalmitis and were excluded from further analysis. Forty-eight eyes did not have cataract surgery. Hence, 350 eyes on 201 dogs were included in the analyses. Among these, 84 eyes (59 dogs) developed a FW. Univariate analyses showed that the odds of FW increased with age and phacoemulsification time. Additionally, FW web was associated lens type, lens brand, and viscoelastic type. Multivariate analyses showed that when comparing lens types in combination with a particular viscoelastic, viscoelastic impacted the estimated prevalence of FW formation the most. In contrast, when the data were analyzed by lens brand, lens brand impacted prevalence more than viscoelastic type. Diabetes mellitus was not associated with FW formation.

CONCLUSIONS

Based on the available data, intraocular lens implantation, viscoelastic type, dog age, and phacoemulsification time were associated with FW formation. Diabetes mellitus, gender, cataract stage, surgeon, intracameral injections other than viscoeleastic, and intra- and postoperative complications were not associated with FW formation.

Pediatric Nd:YAG laser capsulotomy in the operating room: review of 87 cases

AIM

To report a large series of children having Nd:YAG laser capsulotomy in the operating room using the lateral decubitus position.

METHODS

Medical records of children who underwent Nd:YAG laser capsulotomy in the operating room at Ann & Robert H. Lurie Children's Hospital of Chicago between September 2008 and April 2017 were reviewed. Induction of general anesthesia and intubation was performed in the supine position after which the patient was placed in lateral decubitus position. The Nd:YAG laser capsulotomy was performed using a standard protocol. At the completion of the procedure, the patient was turned back into the supine position and extubated.

RESULTS

This study included 87 eyes of 60 patients. Patient's age ranged from 1 to 18y (mean 6.4±4.1y). In most cases (84/87, 97%), the procedure was performed under general anesthesia. In all cases, good focus on the membrane was achieved, and the procedure was performed successfully. There were no intraoperative ocular or anesthesia-related complications.

CONCLUSION

When performing Nd:YAG laser capsulotomy in the operating room, the lateral decubitus position allows an easy and safe approach without the risk of potentially devastating complications that have been associated with the previously described sitting and prone positions.

Minimal surgery achieved good visual acuity in selected patients with magnetic intravitreal foreign body and traumatic cataract

BACKGROUND

To explore minimal surgery in selected patients with intravitreal foreign body (IVFD) and traumatic cataract.

METHODS

Twelve eyes of 12 patients with small ferrous IVFD and traumatic cataract without endophthalmitis, retinal injury and secondary glaucoma, between September 2015 and March 2017 were retrospectively analyzed. Primary removal of IVFD was performed by external magnetic extraction through the pars plana incision. Secondary removal of traumatic cataract by phacoemulsification and intraocular lens (IOL) implantation with or without anterior vitrectomy were performed. Patients were followed up at 1 day, 1 week, 1 month, 3 months, 6 months and 12 months after surgery.

RESULTS

All patients were male with a mean age of 32 years old. All IVFDs were successfully removed without retinal injury. Two to 6 months later, the traumatic cataract was successfully removed by phacoemulsification combined with IOL implantation in the capsule bag in 10 patients. Anterior vitrectomy was implied in 2 patients with large posterior capsule rupture, and the IOLs were placed in the ciliary sulcus. Best-corrected visual acuity ranged from hand movement to 20/100 before surgery and improved ranging from 20/32 to 20/20 at the final follow-up. The IOLs were well centered. Complications such as secondary glaucoma, endophthalmitis and retinal detachment were not found.

CONCLUSIONS

Primary removal of small ferrous IVFD by external magnetic extraction followed by secondary cataract removal and IOL implantation is an appropriate choice. Minimal surgery may obtain good visual outcome without complications in selected patients.

Banded technique for pediatric traumatic cataract surgery

We describe a technique for pediatric traumatic cataract management in cases in which part of the anterior capsule has been ruptured. The technique requires creating a 2-incision push-pull capsulorhexis in the intact anterior capsule. The capsulorhexis is made in a manner that converts the edge of the ruptured anterior capsule into a band of capsule that holds the intraocular lens (IOL) in the bag, reducing the incidence of early, intermediate, or late postoperative lens-iris capture. It also reduces the chances of IOL displacement.

Visual outcomes of pediatric traumatic cataracts

INTRODUCTION:

To report visual outcomes and risk factors of pediatric traumatic cataracts in a tertiary care referral center in northern India.

METHODS:

We analyzed medical records of traumatic cataracts in the pediatric age group (1-15 years) operated for cataract surgery with or without posterior chamber intraocular lens implantation with or without primary posterior capsulotomy with anterior vitrectomy between 2004 and 2012. Causative agents, types of trauma, demographic factors, surgical interventions, complications, and visual acuity were recorded and compared among different groups.

RESULTS:

A total of 147 children were documented to have undergone cataract surgery for traumatic cataract in the study period, male-to-female ratio being approximately 5:1. Mean age was 7.67 ± 3.30 years (range, 1-15 years). Type of primary insult was penetrating injury in 100 (68%) patients and blunt trauma in 47 (32%) patients. Mean interval between injury and cataract surgery in penetrating injury cases was 3.84 ± 7.05 months and in the blunt injury cases was 6.28 ± 11.13 months. Preoperatively, only 110 patients were cooperative for visual acuity. Out of them, none had vision better than 6/18 and only 21 patients (19.9%) had vision of ≥6/60. Visual acuity of 6/18 or better (was considered good visual outcome) was achieved by 87.9%, 97.3%, and 97.9% at 1, 6, and 36 months, postoperatively. Eyes which underwent primary posterior capsulotomy and anterior vitrectomy during cataract surgery showed statistically better visual outcome than those without it.

CONCLUSION:

Phacoaspiration with posterior chamber intraocular lens implantation along with primary posterior capsulotomy and anterior vitrectomy and timely introduction of amblyopia therapy helped in gaining good visual outcome in pediatric traumatic cataract patients irrespective of the age of presentation and the type of injury.

Posterior capsule opacification in pediatric eyes with and without traumatic cataract

PURPOSE

To compare the rate of visually significant posterior capsule opacification (PCO) in pediatric eyes with and without traumatic cataract.

SETTING

Storm Eye Institute, Charleston, South Carolina, USA.

DESIGN

Retrospective case control study.

METHODS

Eyes operated on for traumatic cataract and having in-the-bag single-piece hydrophobic intraocular lens (IOL) implantation were identified. The control group of eyes operated on for nontraumatic cataract was matched with reference to age, management of the posterior capsule, type of IOL, and follow-up duration.

RESULTS

Data from 58 eyes were studied. Age at surgery was comparable between the study group and the control group (7.3 versus 7.8 years) (P = .7). The rate of PCO was statistically significantly different between the 2 groups (12/29 eyes versus 2/29 eyes) (P = .002). This difference was more marked for those with intact posterior capsules (9/12 eyes [75%] and 1/12 eyes [8%] (P = .001) compared with eyes with primary posterior capsulectomy and vitrectomy (3/17 [18%] and 1/17 [6%] (P = .6). For eyes with intact posterior capsules, the duration between cataract surgery and intervention for PCO was 4 to 15 months in the traumatic cataract group; 1 eye in the nontraumatic cataract group required intervention 20 months after surgery.

CONCLUSIONS

Eyes with traumatic cataract were more likely to develop PCO than eyes without traumatic cataract. The results also suggest that PCO develops faster in eyes with traumatic cataract. Primary posterior capsulectomy and vitrectomy should be considered for children having traumatic cataract surgery, irrespective of age at the time of surgery.

FINANCIAL DISCLOSURE

Neither author has a financial or proprietary interest in any material or method mentioned.

Peeling and aspiration of elschnig pearls! An effective alternative to Nd:YAG laser capsulotomy!

To evaluate the efficacy of peeling and aspiration of Elschnig pearls. Retrospective study in a medical college hospital. Records of 217 eyes which underwent surgical peeling and aspiration for membranous PCO between 2006 and 2009, was reviewed. Peeling and aspiration was fashioned with a blunt tipped 20G cannula after stabilizing anterior chamber with anterior chamber maintainer. Post-operative vision and complications were analyzed. Mc Nemar and Chi square tests. The mean age was 56.84 years. 85.71% patients achieved best corrected visual acuity (BCVA) of 20/20 at 3 m. Recurrence of pearls, uveitis and cystoid macular edema were the most common causes of reduced vision. Peeling and aspiration of pearls seem to be a viable alternative to Neodymium yttrium garner aluminium (Nd: YAG) laser capsulotomy for membranous PCO.

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.

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.

Comparison of hospital versus rural eye cAMP based pediatric cataract surgery

Purpose:

To compare the outcomes of pediatric cataract surgery with intraocular lens (IOL) implantation in an eye camp setting and tertiary care center.

Materials and Methods:

Children aged 5-16 years with visually significant cataract underwent phacoaspiration with IOL implantation in an eye camp (eye camp group) or tertiary care center (TCC group). All surgeries incorporated contemporary microsurgical techniques with implantation of polymethyl-methacrylate (PMMA) IOL. Major postoperative complications were managed at a tertiary care center. Postoperative complications, visual acuity and compliance were evaluated using the Chi-square test. A P value less then 0.05 was considered as statistically significant.

Results:

The cohort comprised 59 children in the eye camp group and 48 children in the TCC group. Thirty two of fifty nine (54.23%) eyes in the eye camp group and 30/48 (62.5%) eyes in the TCC group achieved 20/40 or better best corrected visual acuity (BCVA) postoperatively. Postoperatively, 36 (61%) eyes in the eye camp group and 22 (45.83%) eyes in the TCC group required Nd: YAG laser capsulotomy or a pars plana membranectomy. (P> 0.05) The most striking feature was loss to follow up. In the eye camp group, loss to follow was 20% at one year, 49% at two years, 62% at 3 years and 67% at 4 years compared to 12.5, 21, 27 and 33% respectively in the TCC group (P<0.05, all cases).

Conclusions:

The outcomes of camp and tertiary care center (hospital) based pediatric cataract surgery were similar. However, the major drawback of camp based surgery was loss to follow up which eventually affected the management of amblyopia and postoperative complications.

Modern cataract surgery: unfinished business and unanswered questions

We summarize information, based on clinicopathologic studies over the past decade, on various cataract intraocular lens (IOL) procedures and modern "specialized" IOLs, that will help surgeons continuously improve long-term results for cataract patients. Although most operations do initially provide excellent refractive correction and visual rehabilitation, late complications occur. These sometimes are missed because they are outside of the routine period of follow-up care. We have tried to determine if the various techniques and IOLs truly deliver the long-term results that we desire. Most safety and efficacy information is derived from the manufacturer and is passed through the U.S. Food and Drug Administration (FDA). This is often based on limited, relatively short-term observations made by the manufacturer. After a lens receives FDA approval, there are few means to assess the outcome of each procedure and lens years later. We rarely hear of a 10- or 20-year follow-up study. We have found that one of the best means to assess long-term results is pathologic analyses. We discuss recently studied aspects of pathologic reactions, such as posterior capsule opacification, intracapsular fibrosis, glistenings, intralenticular opacification, and other issues with the various IOL platforms; we then present a clinicopathological overview of tissues and IOLs from our database. These include hydrophobic and hydrophilic acrylic designs, plate lenses, and a dual optic lens.

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.

Effect of intracameral cefuroxime on fibrinous uveitis after pediatric cataract surgery

PURPOSE

To determine whether intracameral cefuroxime reduces postoperative fibrin formation after pediatric cataract surgery.

METHODS

Children aged 3 months to 10 years with bilateral congenital or developmental cataracts who underwent surgery between February and July 2008 were eligible for inclusion in this prospective double-masked study. The same surgical technique was used in each eye. The intraocular lens was placed in either the bag or sulcus in both eyes. The same intraocular lens type was used in both eyes (polymethylmethacrylate). One eye was randomized to receive intracameral cefuroxime at the end of surgery and the fellow eye received saline. The surgeon was masked to the treatment assignment. The amount of fibrin formation in the anterior chamber of each eye was assessed by a masked grader on the fourth postoperative day.

RESULTS

Seventy eyes of 35 children were included in the study. Fibrin formation was noted on the fourth postoperative day in 14 of 70 eyes (20%), 7 in the cefuroxime group and 7 in the saline group. The mean fibrin score was 0.57 ± 1.31 in the cefuroxime group and 0.49 ± 1.07 in the saline group. There was no statistically significant difference in the amount of fibrin formation between groups (P = .857, Wilcoxon ranked signs test).

CONCLUSION

Intracameral cefuroxime did not significantly reduce postoperative fibrin formation in this study. Fibrin formation does not appear to be due to bacterial contamination in most cases of pediatric cataract surgery.

The effects of blunt trauma and cataract surgery on corneal endothelial cell density

PURPOSE

This study was designed to investigate the effects of trauma and cataract surgery on corneal endothelial cell density (ECD) in patients with a traumatic cataract due to blunt trauma without globe laceration.

MATERIALS AND METHODS

In this prospective study, 31 subjects with traumatic cataract (traumatic cataract group) and 30 subjects with a senile cataract (control group) were enrolled. The subjects with traumatic cataract were subdivided into two groups: uncomplicated surgery subgroup (n = 19) in which subjects underwent standard phacoemulsification with intraocular lens implantation and complicated surgery subgroup (n = 12) in which subjects underwent cataract surgery other than standard phacoemulsification. The ECD of the traumatic cataract group and the control group was compared preoperatively and at 3 months or later postoperatively. A P value less than 0.05 was considered statistically significant.

RESULTS

The ECD in the eyes with traumatic cataract was 13.1% lower than that for healthy eyes preoperatively (P = 0.043). Postsurgical ECD decreased by 16.7% in complicated surgery subgroup and 11.9% in uncomplicated surgery subgroup (P = 0.049) after 3 months postoperatively. The ECD decreased by 10.8% in the control group (P = 0.489).

CONCLUSIONS

Patients with cataracts due to blunt trauma had a decreased endothelial cell count, which was significantly aggravated by cataract surgery. The loss of corneal endothelium cells due to surgery depends on the surgical approach.

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.

Capsulorhexis ovaling and capsular bag stretch after rigid and foldable intraocular lens implantation

PURPOSE

To compare the amount of capsulorhexis ovaling and capsular bag stretch produced by various intraocular lenses (IOLs) implanted in pediatric human eyes obtained post-mortem.

SETTING

David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Salt Lake City, Utah, USA.

METHODS

In this nonrandomized comparative study, 16 pediatric human eyes obtained postmortem were divided into 2 groups: Eight eyes were obtained from children younger than 2 years (Group A), and 8 eyes were obtained from children older than 2 years (Group B). All eyes were prepared according to the Miyake-Apple posterior video technique. Six types of rigid and foldable posterior chamber IOLs manufactured from poly(methyl methacrylate) (single-piece), silicone (plate and loop haptics), and hydrophobic acrylic (single-piece and 3-piece AcrySof, Alcon Laboratories) biomaterials were implanted. The capsulorhexis opening and capsular bag diameters were measured before IOL implantation and after in-the-bag IOL fixation with the haptics (or the main axis) at the 3 to 9 o'clock meridian. The percentage of ovaling of the capsulorhexis opening was calculated by noting the difference in the opening's horizontal diameter before and after IOL implantation. The percentage of capsular bag stretch was also calculated by noting the difference in the horizontal capsular bag diameter before and after IOL implantation.

RESULTS

All IOLs produced ovaling of the capsulorhexis opening and stretching of the capsular bag parallel to the IOL haptics. There were significant differences in capsulorhexis ovaling and capsular bag stretch (P<.001, analysis of variance) between the 6 IOL types in each group of eyes. The postimplantation difference was significant only between the single-piece hydrophobic acrylic IOL (AcrySof) and the other IOLs. The single-piece hydrophobic acrylic IOL was associated with significantly less capsulorhexis ovaling and capsular bag stretch in both groups (mean 12.06% +/- 0.59% [SD] and 7.6% +/- 1.47%, respectively).

CONCLUSIONS

Modern rigid and foldable IOLs designed for the adult population implanted in the capsular bag of infants and children produced variable degrees of capsulorhexis ovaling and capsular bag stretch. The Miyake-Apple posterior video technique confirmed the well-maintained configuration of the capsular bag (with minimal ovaling) after implantation of a single-piece hydrophobic acrylic IOL because of its flexible haptic design.

Relationship between posterior capsule opacification and intraocular lens biocompatibility

The type of healing process that occurs in response to cataract surgery and intraocular lens (IOL) implantation is dependent on a complex set of variables. Their interactions determine whether or not optical clarity is restored as a result of this procedure. In this process, wound healing entails cells undergoing either epithelial-mesenchymal transition, resulting in the generation of fibroblastic cells and accumulation of extracellular matrix, or lenticular structure formation. Such desperate cellular behaviors are regulated by the localized release of different cytokines, including transforming growth factor beta and fibroblast growth factors, which can result in post-operative capsular opacification. Other factors affecting the biological and mechanical outcome of IOL implantation are its composition, surface properties and shape.

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.

Retrospective evaluation of intraocular lenses in adults younger than 60 years

Data from the U.S. Food and Drug Administration, the American Academy of Ophthalmology's National Eyecare Outcomes Network, and Storm Eye Institute databases were analyzed for short- and long-term safety and efficacy outcomes of intraocular lens (IOL) implantation in adults younger than 60 years and 60 years and older. Statistical analyses for significance were performed where appropriate. A comprehensive literature review was conducted to identify safety and efficacy outcomes and their relationship to patient age at the time of implantation. Analyses established that the performance of IOLs in adults younger than 60 years was comparable to that in adults older than 60 years and supported the use of IOLs in the younger adult population.

Visual results, prognostic indicators, and posterior segment findings following surgery for cataract/lens subluxation-dislocation secondary to ocular contusion injuries

OBJECTIVE

To determine visual outcomes, incidence of posterior segment abnormalities, and prognostic factors in eyes undergoing lens removal for cataract or lens subluxation-dislocation secondary to ocular contusion injuries.

DESIGN

Retrospective, noncomparative, interventional case series.

PARTICIPANTS

Forty eyes in forty consecutive patients undergoing lens extraction for ocular contusion-related cataract or lens subluxation, all with a minimum of 6 months' follow-up.

INTERVENTION

Lens extraction in the traumatized eye.

MAIN OUTCOME MEASURE

Final best-corrected visual acuity.

RESULTS

Final best-corrected visual acuity was 20/40 or better in 55% of eyes, and ambulatory vision (>5/200) was achieved in 88%. Preoperative factors associated with poorer visual outcome (<20/40) were the presence of an afferent pupillary defect or an iridodialysis (P < 0.05). Seventy percent of eyes were determined to have significant posterior segment injuries. The cause of final visual acuity less than 20/40 included macular scarring (23%), retinal detachment (15%), and optic atrophy (5%).

CONCLUSION

Cataract or lens subluxation secondary to ocular contusion injuries is often associated with severe posterior segment sequelae and poor visual outcomes.

Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients

PURPOSE

To identify a delayed complication of cataract surgery in patients with zonular weakness caused by pseudoexfoliation syndrome.

DESIGN

Retrospective observational case series.

PARTICIPANTS

Eight eyes in seven patients with clinically diagnosed pseudoexfoliation syndrome who had undergone previous uncomplicated cataract extraction and placement of a posterior chamber intraocular lens.

METHODS

This study evaluated eight cases of late spontaneous dislocation of posterior chamber intraocular lenses within the capsular bag in patients with pseudoexfoliation syndrome. Data were gathered retrospectively from patients' operative reports, medical records, and pathology reports.

MAIN OUTCOME MEASURES

(1) Interval between original surgery and dislocation; (2) final best-corrected visual acuity and ocular outcome.

RESULTS

All patients had a diagnosis of pseudoexfoliation syndrome and had previously undergone uncomplicated cataract surgery. No patient had any other predisposing factors that would lead to zonular dehiscence or weakness. Delayed dislocation of the entire capsular bag containing the intraocular lens (IOL) occurred spontaneously in all cases. Mean time from IOL implantation to dislocation was approximately 85 months (7 years and 1 month; range, 57-115 months) after surgery. Seven eyes were treated successfully with IOL exchange: six with placement of an anterior chamber IOL and one with scleral fixation of a posterior chamber IOL. The remaining case was treated by scleral fixation of the dislocated IOL. Gross pathology analysis of seven cases confirmed the presence of the IOL within the intact capsular bag. Six eyes have achieved final best-corrected visual acuity of 20/40 or better.

CONCLUSION

Patients with pseudoexfoliation syndrome may be at risk for delayed spontaneous dislocation of IOL within the capsular bag after uncomplicated cataract surgery. Awareness of this newly recognized long-term complication may justify a reevaluation of surgical considerations for cataract removal in these patients.

Intra-ocular lens implantation in children

Intra-ocular lens (IOL) implantation in a growing eye of a young child brings several problems unique to this age group. Better understanding of the rate of refractive growth in children's pseudophakic eyes may help predicting future refractions in these eyes more accurately. Opacification of the posterior capsule, if remained intact, interferes with visual rehabilitation in children. Primary posterior capsulectomy and anterior vitrectomy provides the clarity of visual axis. Optical rehabilitation of children with unilateral aphakia is usually problematic. Posterior chamber IOLs are preferred to anterior-chamber IOLs for secondary implantation. In the absence of adequate capsular support and contact lens intolerance, a scleral-fixated IOL can be implanted. Scleral fixation of a posterior chamber IOL has encouraging short-term results but the long-term risks are not known yet. Intra-ocular lens implantation in infants is associated with major complications and is not recommended at present. The occurrence of open angle glaucoma is a sight-threatening late complication of pediatric cataract surgery. Intra-ocular lens implantation plays a protective role against aphakic glaucoma in children.