Saleem M Akhtar, Abdul Waheed.
Intraocular lenses in Children: Complications and their Management.
Pak J Ophthalmol Jan ;14(3):132-9.

We report the complications and management of intraocular Lens Implantation (IOL) in 35 eyes of 27 children under 12 years of age, observed over 10 years (1988-98). These cataracts were visually significant I.e. reducing vision to less than 6/60. 27 of these were unilateral (traumatic 20, developmental 4, congenital 3) and 8 were bilateral, in four patients (2 developmental and 2 congenital cataracts). Ages at the time of operation ranged from 3 to 12 years for unlocular cataracts and 2 to 7 years in bilateral cases. Follow-up period was 1 to 10 years for unlocular cases and 3 months to 5 years for bilateral cases. Most significant complications were fibrinous uveitis and capsular thickening. Both were worse in younger patients (Age 2 to 5 years). Welds became less virulent with subconjunctival injection of depomedrol and vigorous mydriasis. The marked capsular thickening in extracapsular cataract extractor (ECCE) + IOL required capsulotomy in almost 90% of the cases, mostly within six months of the operation. To counter capsular thickening, later cases were operated on by a modified technique of ECCE + IOL + posterior capsulotomy and anterior vitrectomy where possible. This showed a significant decrease in capsular thickening requiring capsulotomy and much clearer media and visual rehabilitation, with better results. Visual outcome was excellent in 30% (VA 6/12 or better), good in 33% (VA 6/24 to 6/12), fair in 15% (VA 6/60 to 6/24) and poor in 22% of cases (VA less than 6/60). The patients in the last group were cases with macular damage, corneal scarring and amblyopic eyes. Contact lenses were tried in a few patients with poor compliance. Recurring cost extra care, lack of education, unfavourable climatic conditions, with heat and dust and poor socioeconomic status were the main factors for failure of contact lenses. Four patients required anterior chamber lenses (ACLS): two after poor compliance with contact lenses and two with posterior capsular rupture.

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