Traumatic cataracts in young children. Correction of aphakia by intraocular lens implantation

Impact of the possible prognostic factors for visual outcomes of traumatic cataract surgery

BACKGROUND AND OBJECTIVES

This study aimed to investigate the impact of the possible prognostic factors for postsurgical success on visual acuity (VA) in traumatic cataract patients.

MATERIALS AND METHODS

The files of 92 patients (19 women[20.6%]-73 men[79.4%], 44 right-48 left total 92 eyes) who underwent surgery for traumatic cataracts between 2004 and 2018 were retrospectively reviewed for preoperative and final corrected distance VA(CDVA), laterality of trauma, time of admission to a hospital after trauma(TAH), type of injury, location of the injury (zone 1 [corneal], zone 2 [corneal and scleral], zone 3 [scleral]), additional ocular injury, simultaneous or secondary surgery, surgical cataract techniques, and complications.

RESULT

Of the 92 patients enrolled in the study, the mean CDVA was improved from preoperative 1.95 ± 0.49 logMAR to postoperative 0.73 ± 0.72 logMAR.(p < 0.001) In 36.7% of cases, the final CDVA was ≥ 20/40; it was ≥ 20/60 in 58.7%, ≥ 20/200 in 73.9%, and ≥ 20/400 in 94.5%. The strongest correlation was found between postoperative CDVA and preoperative CDVA (Pearson's R = 0.969, p = 0.0001). No correlation was found between CDVA and age, sex, and laterality. The regression analysis showed a significant relationship between the increase in CDVA and TAH, trauma type and location, and surgical timing and techniques. The worst CDVA prognosis was found for patients with a zone 3 injury; patients with a zone 1 injury had the best prognosis. The prognosis is better for a closed globe injury than an open globe injury (p = 0.019). Early TAH was related to a better prognosis than later admissions. No difference was observed between simultaneous and secondary surgeries (p = 0.413) and surgical techniques (p = 0.12).

CONCLUSION

Postoperative CDVA is better in traumatic cataract patients with a better preoperative VA. Early hospital admission after trauma, closed globe, and zone 1 injuries are better prognostic factors than late hospital admission time, open globe, and zone 3 injuries.

Iris-claw versus posterior chamber fixation intraocular lens implantation in pediatric traumatic cataract

Aim:

This study aims to compare visual outcomes and complications of iris-fixated (claw) intraocular lens (IFIOL) implantation with those of posterior chamber intraocular lens (PCIOL) implantation in children with traumatic cataract.

Settings and design:

Retrospective observational clinical audit.

Materials and methods:

A total of 50 pediatric traumatic cataract cases that underwent lens removal and IOL implantation (IFIOL or PCIOL) with or without corneal or corneoscleral tear repair between January 2009 and December 2013 were analyzed. After meeting the eligibility criteria, their pre- and postoperative visual outcomes and complication rates were recorded. Data were analyzed descriptively.

Results:

Out of 50 children, IFIOL and PCIOL implantations were performed in one eye of each of 25 children. Their mean age was 11 ± 4 years (range 4–18 years). Primary (cataract removal with lens implantation) and secondary (corneal tear repair followed by cataract removal with lens implantation) procedures were performed in 19 (76%) and six (24%) children in the IFIOL group and in 21 (84%) and four (16%) children in the PCIOL group, respectively. There was an improvement in best corrected visual acuity postimplantation in both the IFIOL and the PCIOL group, and no significant difference in the logarithm of the minimum angle of resolution of best corrected visual acuity was observed between the two groups over 36 months. Only three eyes in the IFIOL group developed complications: one eye developed secondary glaucoma, one disenclavation of IOL haptic, and one cystoid macular edema.

Conclusion:

Both IFIOL and PCIOL implantations have good visual outcomes and minimal postoperative complications; therefore, IFIOL can be used as an alternative to PCIOL in children with traumatic cataract with inadequate capsular support.

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.

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.

Corneal laceration by sharp objects in children seven years of age and younger

PURPOSE

Young children are prone to develop amblyopia after penetrating injury. We sought to evaluate the management of penetrating corneal injury without intraocular foreign body (IOFB) in children <or=7 years old and to assess the long-term visual acuity results.

METHODS

A retrospective chart review was performed in 2 ophthalmology departments to identify children <or=7 years old with penetrating corneal injury from sharp objects that had follow-up of >18 months. Data retrieved included all details from the initial examination, surgical procedures, amblyopia prevention measures, and final visual acuity.

RESULTS

Twenty children eligible for the study were identified. The mean age was 4.3 years, and mean follow-up time was 58 months. The corneal wound size range was 1-10 mm, with 8 eyes having wounds >or=6 mm. All patients required primary surgical management. Traumatic cataract extraction was performed at the primary operation in 6 eyes, with intraocular lens (IOL) implantation in 4 eyes. Additional surgical procedures were performed in 12 eyes. Yttrium-Aluminum-Garnet (YAG) capsulotomy was performed in 3 eyes with secondary cataract. Twelve patients required spectacle or contact lens correction, and 11 patients had patching for amblyopia prevention. At the end of follow-up, visual acuity was 20/40 or better in 14 eyes, 20/50 to 20/100 in 4 eyes, no light perception (NLP) in 1 eye, and unknown in 1 eye.

CONCLUSIONS

Proper management of penetrating corneal injury in young children can result in excellent visual rehabilitation. Major measures include prompt traumatic cataract extraction with either primary or secondary IOL implantation, opening of posterior capsular opacification with YAG laser, correction of refractive errors, and patching for amblyopia prevention.

EVALUATION OF OPEN GLOBE INJURIES OF CHILDREN IN THE LAST 12 YEARS

PURPOSE

To determine whether advances in vitreoretinal surgical techniques developed over the last decade have translated into improved anatomic and visual outcomes.

METHODS

Retrospective review of children under the age of 18 who were treated for open globe injuries at a children's hospital between January 1990 and December 2002.

RESULTS

The authors identified 59 open globe injuries seen at a single center in the past 12 years. Thirty eyes (51%) required secondary surgery after primary closure. Twelve patients underwent pars plana vitrectomy (PPV), and all presented with an initial visual acuity of count fingers or worse. Seven (58%) had an improvement in vision to 20/200 or better, and 6 (50%) of these patients achieved a visual acuity of 20/50 or better.

CONCLUSION

Improvements in outcome compared to previous studies may signify refinement in technique and an increased utility of PPV over the last 10 years.

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.

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.

Primary cataract extraction and intraocular lens implantation in penetrating ocular trauma

PURPOSE

To analyze the postoperative outcome and complication rate after cataract extraction or lensectomy with primary intraocular lens (IOL) implantation for penetrating traumatic cataract.

DESIGN

Retrospective, nonconsecutive, noncomparative case series.

METHODS

We retrospectively reviewed the files of 21 patients who were admitted to our departments because of traumatic cataract with corneal or scleral laceration caused by penetrating trauma with or without intraocular foreign body (IOFB) from 1992 through 1997. Lens aspiration or manual extracapsular cataract extraction with primary IOL implantation was performed in all patients. Removal of an IOFB was performed in eight patients.

MAIN OUTCOME MEASURES

Final visual acuity and deviation of actual refraction from emmetropia and from expected postoperative refraction.

RESULTS

The mean follow-up was 20.4 months. Fourteen eyes (67%) achieved final visual acuity of 20/40 or better, 95% obtained 20/60 or better final visual acuity, and all eyes achieved 20/100 or better final visual acuity. Major causes of limited visual acuity were central corneal scar and central retinal injury. Eleven eyes (57%) experienced secondary cataract and underwent neodymium:yytrium-aluminum-garnet capsulotomy.

CONCLUSIONS

Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with favorable visual outcome and a low rate of postoperative complications.

A porcine model predicts that a can-opener capsulotomy can be done safely in pediatric patients

PURPOSE

The purpose of this study was to compare the strength and safety of a continuous circular capsulorhexis (CCC) with a can-opener capsulotomy (COC) in a porcine model that closely resembles the high elasticity of the human pediatric lens capsule.

METHODS

COCs (N = 47) and CCCs (N = 102) were performed inside the anterior chamber of fresh pig eyes, and any uncontrolled tears were noted. The circumference of the initial opening was measured in 18 COCs and 13 CCCs. After the opening was stretched to the point of rupture, the circumference was measured again. The ratio of the circumference at rupture to the initial circumference, minus one, was used as a measure of the maximal capsular strain.

RESULTS

The can-opener technique produced a smooth round opening. One of the COCs (2.1%) and 23 of the CCCs (22.5%) had uncontrolled tears (chi2, P<.001). The mean maximal strain for COCs was 46.7% (SE, 8.3%) and for the CCCs, 47.7% (SE, 9.9%). This difference was statistically not significant (P = .93 by Student's t test).

CONCLUSIONS

The porcine capsule is more reliably opened with fewer uncontrolled tears by a COC than by a CCC. The porcine model predicts that pediatric capsules can be opened safely with a COC.

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 outcomes after surgery for unilateral cataract in children more than two years old: posterior chamber intraocular lens implantation versus contact lens correction of aphakia

PURPOSE

We sought to determine whether posterior chamber intraocular lens implantation yields better visual acuity and binocular vision than does conventional contact lens correction of aphakia in similar groups of pediatric cataract patients.

METHODS

We reviewed the medical records of children aged 2 to 16 years who had unilateral cataract surgery by a single pediatric ophthalmologist between 1986 and 1996. Before 1992 all patients underwent standard lensectomy with vitrectomy. Beginning in 1992 posterior chamber intraocular lens (IOL) implantation was offered as a choice to families and was performed on most patients.

RESULTS

Monocular vision outcomes were not significantly different in 20 IOL and 31 lensectomy-vitrectomy patients, with 85% of the IOL group and 77% of the lensectomy-vitrectomy group showing better than 20/100 final acuity. Binocularity, however, was much better in the IOL group, with 90% demonstrating at least 400 seconds of arc stereopsis, as opposed to 39% in the lensectomy-vitrectomy group (p = 0.003). Subgroups of patients with traumatic or nontraumatic cataract origin, age at surgery less than 7 years, and preoperative visual acuity less than 20/100 compared very similarly.

CONCLUSION

Posterior chamber IOL implantation appears to provide significantly better binocular function than conventional management of unilateral cataract in childhood but does not substantially improve visual acuity results.

Traumatic cataract in children: correction of aphakia by contact lens or intraocular lens

PURPOSE

To compare the postoperative complications, visual outcome, and incidence of strabismus in children suffering from traumatic cataract corrected with contact lens or intraocular lens and to follow up the refractive changes in these eyes for an extended period of time.

METHODS

Forty children, 2 to 13 years old at time of surgery for unilateral traumatic cataract, were followed up for 1.5 to 11 years. Seventeen children were corrected with contact lenses and 23 with intraocular lenses. Thirty-two underwent a primary posterior capsulectomy and anterior vitrectomy.

RESULTS

The mean follow-up after surgery was 7.4 years for the children with contact lenses and 6.2 years for those with intraocular lenses. The incidence of secondary surgical interventions was higher among the children corrected with contact lenses. The eight children (five with contact lenses, three with intraocular lenses) who did not undergo primary posterior capsulectomy had Nd:YAG capsulectomy within 1 year after surgery. Fifteen of the 23 children with intraocular lenses (65.2%) achieved a best-corrected visual acuity of 20/40, and 17 children (73.9%) had a final visual acuity of 20/50, but only five of 17 children with contact lenses (35.3%) achieved this level of visual acuity.

CONCLUSIONS

Correction of unilateral aphakia by intraocular lens in children after traumatic cataracts results in better final visual acuities and binocularity with a smaller incidence of strabismus than when correction is carried out by contact lens. Intraocular lens implantation should be considered the primary aphakic correction in children with traumatic cataract.

Management of traumatic cataract in children

PURPOSE

To evaluate the presentation, mode of management, and clinical outcome of traumatic cataract in children.

SETTING

L.V. Prasad Eye Institute, Hyderabad, India.

METHODS

One hundred thirty-seven children (< 16 years) who developed traumatic cataract, seen between January 1988 and December 1993, were retrospectively analyzed. Nature of injury, type of cataract, management, and outcome were evaluated.

RESULTS

The study group comprised 110 boys and 27 girls. Average follow-up was 11.7 months (range 1 week to 60 months). Most injuries (54.7%) were caused by a stick or a bow and arrow. Most (53.2%) of the cataracts were total. Corneal scarring (60.5%) and iris-related problems (49.6%) were the most common associated findings. Extracapsular cataract extraction with intraocular lens (IOL) implantation was performed in 65.67% of patients. Visual acuity improved form 20/200 or worse in 97.7% of patients preoperatively to 20/60 or better in 74.1% or patients postoperatively. Seventeen patients had associated posterior segment insult; most failed to recover satisfactory vision. Posterior capsule opacification (PCO) was noted in 42.9% of patients.

CONCLUSIONS

Extracapsular cataract extraction with IOL implantation provides satisfactory results in children with traumatic cataract. Associated posterior segment complications and development of PCO are the major obstacles to visual rehabilitation.

Secondary posterior chamber intraocular lens implantation in pediatric patients

PURPOSE

To report results of secondary posterior chamber intraocular lens (IOL) implantation in previously aphakic pediatric patients.

METHODS

In 19 pediatric patients, 19 aphakic eyes (11 after infantile and eight after traumatic cataract surgery) received secondary sulcus-fixated posterior chamber IOL implants.

RESULTS

Visual acuity of 20/40 or better was achieved with IOL implantation and overrefraction in three of 11 infantile (27%) and six of eight traumatic cataract patients (mean follow-ups, 18.1 months [range, 8 to 29 months] and 18.0 months [range, 6 to 28 months]), respectively. Eighteen of 19 patients (95%) demonstrated postoperative vision equal to or better than preoperative levels; 15 of 19 patients (79%) showed improved vision after IOL implantation. The mean +/- SD difference between actual and predicted postoperative refraction at 1 month was -0.97 +/- 0.96 diopter. Average refractive error at last examination was -0.40 +/- 2.43 diopters. Amblyopia therapy was performed in 14 patients. One IOL required repositioning 8 months postoperatively. Strabismus was present in 14 patients before and 13 patients after IOL implantation, requiring surgery in four patients.

CONCLUSIONS

Secondary IOL implantation can be performed successfully in carefully selected pediatric patients. Visual acuity results are better in eyes with a history of traumatic cataract and are influenced by patient compliance. The short-term risks of the procedure appear no greater than those of primary IOL implantation, and complications resemble those seen in adults.

Epilenticular lens implantation versus extracapsular cataract extraction and lens implantation in children

PURPOSE

To compare the results of epilenticular posterior chamber intraocular lens (IOL) implantation and pars plana lensectomy with those of extracapsular lens aspiration and posterior chamber IOL implantation in eyes with pediatric cataracts.

SETTING

Guru Nanak Eye Centre, New Delhi, India.

METHODS

Forty eyes with childhood cataract of varied etiology were divided into two groups of 20 eyes each, matched by age, sex, and type of cataract. Group A had epilenticular IOL implantation with pars plana lensectomy. Group B had extracapsular lens aspiration with posterior chamber IOL implantation. Follow-up ranged from 1 to 3 years.

RESULTS

All 20 eyes in Group A maintained a clear pupillary axis from the immediate postoperative period to the last follow-up. In Group B, 80% of eyes developed varying degrees of posterior capsule opacification (PCO), which hampered vision. In Group A, 95% of eyes had a visual acuity of 6/12 or better; only 45% of eyes in Group B achieved a visual acuity of 6/60 or better.

CONCLUSION

Although patients in both groups had good visual recovery, those having epilenticular IOL implantation with pars plana lensectomy maintained a clear pupillary axis and did not develop PCO, preventing the need for secondary intervention.

Unilateral pseudophakia in children under 4 years

PURPOSE

We examined the efficacy of intraocular lens implantation (IOL) in children younger than 4 years of age for unilateral aphakic visual rehabilitation.

METHODS

Twenty-one patients underwent unilateral cataract extraction, IOL placement, posterior capsulotomy, and anterior vitrectomy between 1990 and 1994. Postoperative vision, refractive change, and complications were monitored prospectively. Two cataract subgroups were analyzed: 12 patients with infantile (congenital and developmental) cataracts, and nine patients with posttraumatic cataracts.

RESULTS

Overall age at surgery averaged 26 months (range 9 to 44 months), with follow up of 5 to 55 months. Fifty-two percent achieved 20/40 or better vision: 42% in the infantile group and 67% in the traumatic group. IOL power averaged 22.6 diopters (D). The difference between predicted and actual postoperative refraction was less than 1 D in 70%. After 6 months, the average change in refraction was 0.50 D (21 patients). An increasing myopic shift of 1.10 D at 12 months (14 patients), 1.80 D at 18 months (nine patients), and 2.90 D after 24 months (eight patients) was noted. This trend was greater in the infantile group. Amblyopia treatment was implemented in 18 patients. Half have completed occlusion successfully, one third continue therapy, 17% are treatment failures, and 11% (two patients) were lost to follow up. Six patients required strabismus surgery; five had infantile cataracts. Postoperative complications occurred in four eyes, two infantile and two traumatic; they consisted of posttraumatic temporal IOL dislocation, corectopia, partial pupillary capture of an IOL, and partial pupillary membrane.

CONCLUSION

Primary IOL implantation is an effective way to rapidly achieve aphakic visual rehabilitation in preschool children. We continue to evaluate the long-term safety and effects of pediatric pseudophakia.

Posterior chamber intraocular lenses: long-term results in pediatric cataract patients

Major problems in pediatric cataract patients include noncompliance with contact lenses resulting in amblyopia. Advances in intraocular cataract surgery have provided a better environment to perform intraocular lens (IOL) implantation in children. We prospectively analyzed the results of 34 consecutive pediatric patients who underwent cataract removal and insertion of an IOL. Operative technique performed was posterior scleral beveled or frown incision and IOL endocapsular fixation. Subgroups included 10 eyes with traumatic cataract, and 24 eyes with developmental cataracts. Six patients had bilateral IOLs. Data presented in each subgroup included initial and final visual acuity, age, sex, type of cataract, A and B scan biometry, early and late postoperative complications, time of YAG capsulotomy, postoperative refractive correction, and state of binocular vision. Preoperative visual acuity ranged from 20/70 to light perception. The success rate for postoperative visual acuity of 20/40 or better occurred in 29 of 34 eyes, or 85.3%. In the traumatic cataracts, 8 of 10 eyes (80%) obtained 20/40 vision or better. In developmental cataracts, 21 of 24 eyes (88%) achieved visual acuity of 20/40 or better. Amblyopia (three patients) or macular scar (two patients) accounted for reduced visual acuity in the five eyes with vision less than 20/40. Early complications included posterior synechiae and lens deposits. The primary late complication was opacification of the posterior capsule in 18 of 34 eyes. The average time for YAG capsulotomy post-cataract removal was 17 months. None of the 28 patients (34 eyes) developed glaucoma, IOL dislocation, or other significant postoperative problems related to IOL insertion.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors affecting visual outcome in children following uniocular traumatic cataract

The correction of paediatric traumatic aphakia remains a controversial topic. This study examines retrospectively the visual outcome in 32 children with uniocular traumatic cataracts. Fifteen received intraocular lens implants following lensectomy, and 17 received aphakic contact lenses. Age range was 2-14 1/2 years at the time of injury. The maximum follow-up time was 13 years. Twenty-four children obtained a good visual result (6/5 to 6/18). These were equally divided between those receiving intraocular lens implants and those with contact lenses. Factors adversely affecting visual outcome are discussed. These include complex trauma, delay in referral for lensectomy, inadequate postoperative correction of aphakia, contact lens difficulties and problems with occlusion therapy. Although aphakic correction with intraocular lens implants may require several subsequent surgical procedures such as capsulotomy, we advise early lensectomy and intraocular lens implantation where possible, particularly in young children with traumatic cataracts. This eliminates contact-lens-associated problems and maximises the chance of good visual outcome and retention of stereoscopic vision.

Intraocular lens implantation in infants with congenital cataracts

We evaluated 21 eyes of 13 infants between two and eight months old who had primary posterior chamber intraocular lens (IOL) implantation for congenital cataracts between 1988 and 1993. Twelve eyes had a posterior capsulorhexis or plaque peeling at the time of implantation and one eye had a vitrectomy. Eight eyes had no posterior capsule procedure during the initial surgery. Follow-up ranged from six months to five years. All eyes developed one or multiple posterior synechias and all, except one, required secondary capsulectomy and vitrectomy between one month and one year. Twenty eyes attained stable IOL fixation and a clear visual axis. In one eye, the IOL decentered downward. Patients with bilateral cataracts had greater visual improvement than those with a cataract in one eye only. No patient could manage spectacles postoperatively. Our findings show the benefits of posterior capsulectomy and anterior vitrectomy done in the early postoperative period and that IOL implantation in infants is a reasonable treatment in some parts of the world.

Posterior capsulorhexis with optic capture: maintaining a clear visual axis after pediatric cataract surgery

We describe a technique for preventing secondary membrane formation after pediatric cataract extraction. This technique involves capture of an intraocular lens (IOL) optic through a posterior curvilinear capsulorhexis opening in an attempt to maintain a clear visual axis in children after cataract surgery. This maneuver ensures centration of the posterior chamber IOL because the haptics remain in the capsular bag and the optic is captured in the posterior capsular opening. Also, the need for an anterior vitrectomy may be eliminated. Apposition of the anterior and posterior capsule leaflets anterior to the optic may limit the migration of Elschnig pearls, reducing the incidence of secondary membranes and the need for additional procedures.

Pseudophakia for traumatic cataracts in children

PURPOSE

The purpose of this prospective study is to evaluate the postoperative visual acuity, refractive error, intraocular pressure, and status of the posterior capsule in children with traumatic cataracts who undergo extracapsular cataract extraction and insertion of a posterior chamber lens.

METHODS

Extracapsular cataract extraction and primary endocapsular fixation of a posterior chamber lens implant were performed in eight children (age range, 4-17 years) with unilateral traumatic cataracts.

RESULTS

There were no intraoperative complications, and seven of eight eyes achieved 20/40 or greater spectacle visual acuity during an average follow-up interval of 10 months (range, 5-20 months). The average postoperative spherical equivalent refractive error was +0.33 diopter (D) (range, -2.25 to +2.12 D); the average postoperative anisometropia was approximately 1 D (range, 0-2.25 D). In one patient, a coagulase-negative staphylococcal endophthalmitis developed 10 days after surgery. In three eyes that had opacified posterior capsules, YAG laser capsulotomy was performed.

CONCLUSIONS

These preliminary results suggest that intraocular lens (IOL) implantation may be a safe and effective method of optical correction for children with traumatic cataracts.

Management of the posterior capsule during pediatric intraocular lens implantation

One of the major obstacles in pediatric intraocular lens implantation has been the subsequent dense opacification of the posterior capsule. We used a modification of the standard pediatric cataract surgical procedure, which involved endocapsular cataract extraction, posterior chamber intraocular lens implantation, pars plana posterior capsulotomy, and pars plana anterior vitrectomy in 20 consecutive patients with unilateral traumatic, radiation-induced, and developmental cataracts. Visual axes were rapidly restored in all patients without further intervention for posterior capsule opacification. Visual acuity returned to 20/40 or better in all patients and 75% of all patients (15 patients) reached maximum improvement by five weeks. No complications attributed to intraoperative removal of the posterior capsule occurred.

Primary posterior chamber IOL implantation in penetrating ocular trauma

This paper describes the experience of primary cataract extraction and posterior chamber IOL implantation in 11 eyes with penetrating ocular trauma. The primary surgical procedure consisted of repair of corneoscleral laceration, cataract extraction, posterior chamber IOL implantation and in certain cases, removal of intraocular foreign body and vitrectomy. 10 out of 11 cases had a post operative visual acuity of 6/18 or better, with 9 out of 11 having a post operative visual acuity of 6/12 or better. One case initially had a visual acuity of 6/24 but later developed retinal detachment with a visual acuity of 'hand movements'. Another patient developed a small localised retinal detachment during the tenth postoperative month but with successful surgery, attained a visual acuity of 6/6. The encouraging results suggest that this procedure may be recommended in carefully selected cases, under the management of an experienced surgeon.

Intraocular lens implantation in developing countries

One of the chief aims of ophthalmic workers in developing countries is to operate on as many cataract patients as possible in the most cost-efficient manner. Therefore, our intraocular lens (IOL) implantation policy in Nakuru and Kikuyu, Kenya, is to reserve IOLs for monocular cataract patients of all ages, who otherwise would not have use of the aphakic eye. In this study, we review 105 of our first IOL implantations. In 60%, the uncorrected postoperative visual acuity was 20/60 or better.

Intraocular lens implantation in children with unilateral traumatic cataract

A group of 23 children with traumatic pseudophakia was evaluated. Intraocular lens (IOL) implantation was performed as a primary procedure, immediately after aspiration of the traumatic lens, in 7 cases and as a secondary procedure in 16 cases. The mean followup was 6.5 years, varying from 1.5 to 11 years. A visual acuity of 0.7 or more was achieved in 3 of the 8 patients under 7 years of age and in 13 of the 15 cases from 7 to 14 years of age. Awaiting longer follow-up results of epikeratophakia in children we advise to perform early IOL implantation in children under 7 years of age, combined with a rigid amblyopia treatment scheme. In children older than 7 years of age we prefer to try the use of contact lenses first and preserve IOL implantation for selected cases.

Pseudophakia in children: precautions, technique, and feasibility

Intraocular lens implantation in young children can yield satisfactory results when the surgical techniques are modified and adapted to the child's eye. Between June 1983 and July 1988, 84 posterior chamber lenses were implanted in 80 children aged 2 months to 8 years. An elective posterior capsulotomy followed by an anterior vitrectomy was performed in all cases prior to the lens insertion. This step allowed a permanent clear visual axis which in turn has facilitated visual rehabilitation of the pseudophakic eye. The best results occurred in the developmental cataract group followed by the traumatic cataract group; the poorest visual outcome occurred in patients with unilateral congenital cataracts. Amblyopia treatment and alternative methods of correcting pediatric aphakia are discussed.

Paediatric aphakic epikeratoplasty: early Australian experience

Epikeratoplasty has been performed on eight eyes of seven patients by one surgeon in Melbourne since March 1988. All cases were contact lens or spectacle intolerant. Standard surgical techniques utilising donor lenticules imported from the United States and including an annular keratectomy were employed for the procedure. An eight-month follow-up is available for the first two cases, aged two and 10 years. The elder of these children has achieved corrected acuity of 6/9 in each eye. Refractive and early visual acuity results are presented for the five other cases which have at least two months of follow-up. The results indicate that in appropriately selected patients, epikeratoplasty offers a safe, effective modality for visual restoration and development in otherwise untreatable aphakic children.