IOL implants an option in pediatric traumatic cataracts

December 1, 2005

Phoenix—Children with traumatic cataract often achieve a good visual outcome after cataract removal and primary IOL implantation, said Richard L. Golub, MD.

"Visual axis opac-ification and am-blyopia are the two most important factors limiting visual outcome in these cases, and children with traumatic cataracts are at increased risk for developing visual axis opacification, particularly if the posterior capsule is left intact at the initial surgery," Dr. Golub noted.

He reported the best-corrected visual acuity (BCVA) outcomes and postoperative complications from a retrospective analysis of 48 pediatric eyes with traumatic cataracts that underwent primary IOL implantation.

A review of the demographic features of the children in the study showed that, similar to other series of pediatric traumatic cataract cases, the group was composed of three-fourths males. Mode of injury was blunt trauma in 58% of eyes and penetrating trauma in 42%. BB gun injury and injury from a tree branch or vegetable matter were the most common mechanisms of trauma (six cases each).

At the time of injury, the children ranged in age from < 2 years to 14 years; 14 children were in the 4- to 6-year-old age range, 13 were > 6 to 10 years old, and eight were > 12 to 14 years old. Age at time of surgery ranged from 28 to 167 months.

Intraoperatively, half of the eyes were found to have an anterior capsule tear while the posterior capsule was disrupted in 19%. Primary IOL implantation was performed in the bag in 33 eyes and in the ciliary sulcus in 12. An optic capture technique with the haptics placed in the sulcus and the optic captured through the anterior and/or posterior capsules was performed in three cases.

After a mean follow-up of 16.3 months, there was a wide range in BCVA outcomes, but 59% of eyes achieved a BCVA of 20/40 or better. BCVA was 20/50 to 20/80 in 23% of eyes and 20/80 or worse in 18%.

Blunt versus penetrating trauma

Median postoperative BCVA was similar whether the mode of trauma was blunt (20/34) or penetrating (20/30).

"That result was somewhat surprising," Dr. Golub said. "However, considering that our study included a relatively small number of eyes, no definitive conclusions can be made about the relative visual outcomes after those different types of injuries."

Visual axis opacification occurred in 12 eyes. Among patients who had intact posterior capsules left after surgery, 70% developed visual axis opacification compared with < 5% of those who had a primary posterior capsulotomy.

A comparison with age-matched controls from the center's database showed there was a significant increased risk of visual axis opacification in children with traumatic cataracts versus those with nontraumatic cataracts whether they had an intact posterior capsule after surgery (relative risk, 1.78) or had a primary posterior capsulotomy (relative risk, 1.58).

Leaving an intact posterior capsule also increased the risk for needing a secondary surgical intervention. Among eyes with an intact posterior capsule, additional surgery was needed in 71% compared with 3% of eyes without intact posterior capsules.

Other postoperative complications in the series included pupillary capture in three eyes and IOL dislocation in one eye.