Factors associated with second eye cataract surgery

AIMS—To analyse the clinical and sociodemographic characteristics associated with second eye cataract surgery.
METHODS—An observational, longitudinal study of patients scheduled for first eye cataract surgery that did not involve a combined procedure was carried at two teaching hospitals and one non-teaching hospital in Barcelona, Spain. Patients were followed for 2 years after first eye cataract surgery to assess whether and when they had undergone second eye cataract surgery. Clinical characteristics, perceived health characteristics (perceived visual function and overall health status), and sociodemographic characteristics were compared between two patient groups—those with surgery in only one eye and those who had undergone surgery in both eyes by the end of the 2 year follow up period.
RESULTS—Of the 242 patients studied, 125 (51.7%) underwent second eye surgery during the 2 year observation period. Patients with visual acuity 6/18 (0.3) or worse in the second eye compared with those with visual acuity over 6/12 (0.5) and patients younger than 65 years compared with patients aged 65-74 were more likely to undergo second eye surgery (adjusted odds ratio 3.9 and 1.8, respectively). 52 (44.5%) patients in the only one eye surgery group had a visual acuity less than 6/18 (0.3) in the second eye.
CONCLUSIONS—Worse visual acuity in the second eye and younger ages are strongly associated with both eyes cataract surgery. There may be a potential increase of demand for this procedure in the near future since almost half of the patients with only one eye surgery presented a low visual acuity in the second eye.

     

Impact of cataract surgery on car driving: a population based study in Sweden

AIMS—To investigate the outcome of cataract surgery on the patients' self estimation of visual function while driving. Furthermore, the benefit of surgery to the car driving population was determined.
METHODS—A total of 208 consecutive patients (211 cases) with driving licences, who underwent cataract surgery with intraocular lenses, were studied prospectively using self administered questionnaires. Their self estimated degree of visual functional problems while driving were analysed before and after surgery.
RESULTS—Visual problems while driving declined from 82% preoperatively to 5% after surgery. Remaining visual problems with the operated eye were present in only seven patients. Problems in estimating distance while driving decreased from 37% before surgery to 6% after surgery. Twenty three per cent of the patients drove with a visual acuity below the requirements for driving in Sweden before surgery and only 4% after surgery. There was no correlation between the degree of visual problems while driving and visual acuity before surgery.
CONCLUSION—The car driving population greatly benefited from cataract surgery in terms of subjectively improved visual function and distance estimation while driving. Functional visual problems while driving should be considered as an indication for cataract surgery. These findings also indicated that the second eye should be operated on, if necessary, to achieve optimal ability to estimate distance and give best possible road safety.

     

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 (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.

Keywords: binocular vision; intraocular lens; paediatric cataract; visual outcome     

Visual functioning and quality of life outcomes among cataract operated and unoperated blind populations in Nepal

BACKGROUND—Visual acuity and vision related quality of life outcomes in cataract surgery were evaluated in a population based survey in two geographic zones in Nepal.
METHODS—Case finding was based on random sampling using a stratified cluster design with door to door enumeration of people aged 45 years followed by eye examinations at village sites. All aphakics/pseudophakics, those with visual acuity less than 6/60 in either eye, and a sample of those with normal visual acuity were administered visual functioning (VF) and quality of life (QOL) questionnaires.
RESULTS—15% of the 159 cataract operated cases had presenting visual acuity 6/18 in both eyes, 38% with best corrected visual acuity. 21% were still blind with presenting visual acuity <6/60 in both eyes, 7% with best correction. On a 0-100 scale, mean VF and QOL scores were 87.2 and 93.9 respectively in normally sighted unoperated individuals, dropping to 15.6 and 29.5 for those severely blind (<3/60). Among the cataract operated, mean VF and QOL scores were 47.5 and 55.4, respectively. VF and QOL scores correlated with vision status at statistically significant levels (p <0.0001)
CONCLUSION—Cataract surgery outcomes, whether measured by traditional visual acuity or by patient reported VF/QOL, are at levels many would consider unacceptably low. It is apparent that in the quest to reduce cataract blindness much more attention must be given to improving surgery outcomes.

Keywords: cataract surgery; visual acuity; visual functioning; quality of life     

Variation in indications for cataract surgery in the United States, Denmark, Canada, and Spain: results from the International Cataract Surgery Outcomes Study

BACKGROUND/AIMS—International comparisons of clinical practice may help in assessing the magnitude and possible causes of variation in cross national healthcare utilisation. With this aim, the indications for cataract surgery in the United States, Denmark, the province of Manitoba (Canada), and the city of Barcelona (Spain) were compared.
METHODS—In a prospective multicentre study, patients scheduled for first eye cataract surgery and aged 50 years or older were enrolled consecutively. From the United States 766 patients were enrolled; from Denmark 291; from Manitoba 152; and from Barcelona 200. Indication for surgery was measured as preoperative visual status of patients enlisted for cataract surgery. Main variables were preoperative visual acuity in operative eye, the VF-14 score (an index of functional impairment in patients with cataract) and ocular comorbidity.
RESULTS—Mean visual acuity were 0.23 (USA), 0.17 (Denmark), 0.15 (Manitoba), and 0.07 (Barcelona) (p<0.001). When restricting the sample to eyes with normal retina and macula, no significant difference between United States and Denmark was observed (p>0.05). Mean VF-14 scores were 76 (USA), 76 (Denmark), 71 (Manitoba), and 64 (Barcelona) (p<0.001).
CONCLUSION—Similar indications for cataract surgery were found in the United States and Denmark. Significantly more restricted indications were observed in Manitoba and Barcelona. Possible explanations for the results are discussed, including differences in sociodemographic characteristics, access to care, surgeons' willingness to operate, and patient demand.

Keywords: cataract surgery; North America; Europe     

Long term clinical outcome of a randomised controlled trial of anterior chamber lenses after high volume intracapsular cataract surgery

BACKGROUND—Age related cataract remains the major cause of blindness throughout the world. In many countries, the majority of cataract surgery continues to be done by the intracapsular cataract extraction (ICCE) method. The results of a large randomised controlled trial of multiflex open loop anterior chamber intraocular lenses (ACIOL) were reported from a busy eye hospital in Nepal.
METHODS—There was a randomised controlled trial of 2000 people with bilateral cataract reducing vision to less than 6/36. Interventions were ICCE with an ACIOL compared with ICCE with aphakic spectacles (+11 dioptres). Participants were followed at discharge, 6 weeks, 1 year, and 11/2-5 years after surgery. Visual acuity and clinical outcome were measured. A poor outcome was defined as vision <6/60.
RESULTS—Visual outcome was comparable in the two groups. More of the control group experienced functional blindness due to loss of aphakic spectacles at 1 year. The majority of cases of poor outcome occurred in the first year after surgery. There was no indication of any lens related problems after 1 year.
CONCLUSION—Multiflex open loop anterior chamber lenses are safe for up to 1 year of follow up when used by experienced surgeons, and the available evidence of 2-5 years of follow up suggests that the complication rate is reasonably low. An ACIOL at the time of cataract surgery offers benefits over routine ICCE surgery with aphakic spectacle correction as it avoids the problem of replacing lost and broken spectacles.

     

Prevalence of blindness and cataract surgery in Nepal

BACKGROUND—A national eye care programme was launched in Nepal in the early 1980s. The impact of this programme on blindness and cataract surgery prevalence was evaluated in two geographic zones.
METHODS—People aged 45 years and older were sampled using a stratified cluster design. Within randomly selected clusters, door to door enumeration was followed by visual acuity measurement and eye examinations at conveniently located sites. The full survey was preceded by a pilot study where operational methods were refined and quality assurance measures carried out.
RESULTS—Of the 5112 enumerated individuals 90% were examined. Blindness, defined as presenting visual acuity less than 6/60 in both eyes, was found in 5.3% (95% CI 3.6, 6.8) of individuals examined, with cataract being the principal cause in at least one eye in 78% of cases. Considering both cataract operated and unoperated cataract blind cases, surgical coverage was approximately 42%.
CONCLUSION—The findings suggest that blindness prevalence may have decreased slightly from that estimated in a 1981 national survey, both overall and cataract related. Similarly, cataract surgical coverage may have increased somewhat. None of these changes, however, are at statistically significant levels. Accordingly, the blindness problem remains challengingly high.

Keywords: blindness prevalence, cataract blindness, aphakia/pseudophakia     

Pulfrich's phenomenon in unilateral cataract

AIMS—To determine whether unilateral cataract causes a pathological Pulfrich's phenomenon.
METHODS—29 subjects with unilateral cataract and contralateral pseudophakia were assessed on their ability to perceive the Pulfrich phenomenon. Using a computer generated pendulum image, and graded neutral density filters, a series of forced choice trials were performed in which the subject was required to describe the direction of any apparent pendulum rotation. A pathological Pulfrich effect was said to occur when apparent rotation was perceived in the presence of a zero strength neutral density filter. The size of any pathological Pulfrich effect which was present was quantified by neutralising the perceived pendulum rotation with neutral density filters of varying strength placed before the better seeing eye.
RESULTS—20 out of 29 subjects were able to perceive apparent pendulum rotation when uniocular filtering was performed. In the group (n=12) which was tested both before and after cataract extraction with intraocular lens implantation, a statistically significant pathological Pulfrich effect was demonstrated preoperatively, compared with a group of normal control subjects. This effect was abolished after cataract extraction (p=0.009). The median size of the effect was equivalent to a 0.25 log unit neutral density filter over the non-cataractous eye. The subjects who were unable to perceive the Pulfrich phenomenon at all had a significantly greater difference in the visual acuity of each eye (p=0.045) and significantly worse stereoacuity than those who were able to perceive the effect (p=0.002).
CONCLUSIONS—Unilateral cataract can cause a pathological Pulfrich phenomenon. This finding may explain why some patients with unilateral cataract complain of visual symptoms that are not easily accounted for in terms of visual acuity, contrast sensitivity, or stereoacuity.

     

Retinal detachment in AIDS: long term results after repair with silicone oil

AIMS—To study the long term results of vitrectomy and silicone oil injection in AIDS patients with retinal detachment due to viral retinitis.
METHODS—A consecutive series of 83 eyes in 75 AIDS patients who were treated with vitrectomy and silicone oil for retinal detachment due to viral retinitis was studied prospectively and followed until the last patient in the series had died.
RESULTS—Median postoperative survival was 6 months, but 20% of patients survived 12 months or more. Whereas best corrected visual acuity was 20/100 or better in over half the patients 1-2 months after operation, there was a distressing decrease in acuity by 6 months, owing to a variety of factors. Patients operated on before macular detachment did not have significantly better postoperative vision than those operated within a week after macular detachment. Almost all patients who had already lost vision in the fellow eye and many who had cytomegalovirus retinitis in the fellow eye with retention of good vision had their quality of life improved by the surgery in that the operated eye eventually became the better seeing eye. In no patient whose fellow eye was normal and free of retinitis, however, did the operated eye ever become the better eye.
CONCLUSIONS—Although the majority of patients recovered macular vision in the first 1-2 months after operation, there was a gradual decline in acuity thereafter, sometimes without obvious cause. The results of this series suggest that it may be reasonable to postpone surgery until the macula detaches and that patients whose fellow eye is free of retinitis with normal vision are unlikely to have their quality of life improved significantly by the surgery.

     

A clinic based survey of blindness and eye disease in Cambodia

AIMS—To survey the spectrum of eye disease presenting to rural eye clinics in Cambodia.
METHODS—A total of 1381 patients seen consecutively at 13 eye clinics were examined and the findings recorded.
RESULTS—231 (16.7%) were bilaterally blind (visual acuity <3/60 in both eyes); 263 (19%) were unilaterally blind, and 169 (12%) had low vision (visual acuity <6/18 in the better eye). Cataract was the commonest cause of visual loss in all three categories and was responsible respectively in 69%, 40%, and 55% of each group. Trachoma was diagnosed in 13% of patients. Thirty three of them needed lid surgery for trichiasis.
CONCLUSION—With the difficult practical and political situation in Cambodia there seems little prospect of making substantial inroads into the backlog of avoidable blindness in the near future.

     

Risk of endophthalmitis after cataract extraction: results from the International Cataract Surgery Outcomes study

AIM—To estimate risk of infectious endophthalmitis after cataract extraction in Denmark and to compare results with the risk of this complication in the USA
METHODS—In the national Danish administrative hospital register, 19 426 patients were identified who underwent first eye cataract surgery from 1985 to 1987 and who were 50 years of age or older. Of these, 61 patients had postoperative endophthalmitis.
RESULTS—A 12 month cumulative risk of rehospitalisation for endophthalmitis was estimated at 0.18% (95% CI 0.09-0.26) after extracapsular cataract extraction with lens implant. Advanced age, male sex, intracapsular cataract extraction, and anterior vitrectomy were all associated independently with an increased risk of postoperative endophthalmitis. When restricting the sample to patients aged 65 years or older, in order to allow comparisons to be made with the US National Study of Cataract Outcomes, a 12 month risk of 0.17% (95% CI 0.08-0.25) was estimated. The previously reported US risk of 0.12% is included in the confidence interval of the risk estimated in the Danish sample.
CONCLUSION—Despite considerable differences in the healthcare systems, no statistically significant difference in outcome of surgery as measured by risk of endophthalmitis was shown between Denmark and the USA.

     

Do patients with age related maculopathy and cataract benefit from cataract surgery?

AIMS—To assess the benefits of cataract extraction in patients with age related maculopathy (ARM).
METHODS—1073 randomly selected cataract operations were reviewed and 99 cases of preoperatively recognised ARM were identified for investigation. Data relating to visual function were retrieved from case notes, and patient responses to a questionnaire were analysed.
RESULTS—98% had dry or unspecified ARM. Only 2% had exudative maculopathy. 81% of cases had an improvement in best distance acuity; mean change 0.44 logMAR (change of 6/36 to 6/12). 65% responded to the questionnaire; 67% felt that the operation had been worthwhile, 17% had mixed feelings, and 17% thought it not worthwhile.
CONCLUSION—This study, which is the first of its kind to be reported, shows a clear benefit from cataract surgery in the majority of patients with ARM. However, the prevalence of ARM in this study is lower than expected, suggesting that some patients with both ARM and cataract were not listed for surgery. The design of a prospective study to quantify the subjective and objective benefits of cataract surgery in these patients is outlined and predictors of successful outcome identified. This will promote the development of guidelines for the surgical management of this group of patients.

Keywords: age related maculopathy; cataract; cataract surgery; outcome assessment; questionnaire     

Blindness and visual impairment in a region endemic for onchocerciasis in the Central African Republic

AIMS—A population based survey of blindness and visual impairment was conducted in the district of Bossangoa, Central African Republic.
Methods—A total of 48 communities were randomly selected, and 6086 people examined.
RESULTS—The prevalence of blindness (visual acuity in the better eye less than 3/60) was 2.2%, and visual impairment 3.0% (6/24 to 3/60 in the better eye). The major causes of blindness were onchocerciasis (73.1%), cataract (16.4%), trachoma (4.5%), and glaucoma (2.2%).
CONCLUSION—Around 95.5% of all blindness could potentially have been prevented or treated. Ivermectin mass distribution is hoped to prevent 50% of all forms of visual loss in the future.

     

Topical anaesthesia with oxybuprocaine versus sub-Tenon's infiltration with 2% lignocaine for small incision cataract surgery

AIMS—To determine whether topical anaesthesia in small incision self-sealing phacoemulsification cataract surgery provides comparable anaesthesia to sub-Tenon's infiltration.
METHODS—Thirty five patients undergoing small incision self-sealing phacoemulsification cataract surgery were allocated randomly to receive topical anaesthesia with 0.4% oxybuprocaine or sub-Tenon's infiltration with 2% lignocaine. Pain experienced during the operation was assessed by asking the patient to score on a visual analogue graphic pain score chart.
RESULTS—The median pain score for the topical group (3) was significantly higher than that of the sub-Tenon's group (0) (p = 0.004).
CONCLUSION—Sub-Tenon's infiltration is superior to topical anaesthesia in ensuring patient comfort during small incision scleral tunnel self-sealing phacoemulsification cataract surgery.

     

Influence of advanced recipient and donor age on the outcome of corneal transplantation

AIMS—The aims of this study were to examine the influence of advanced recipient and donor age on the long term outcome of corneal transplantation.
METHODS—Records of 1036 penetrating corneal grafts in recipients aged 80 years at surgery (defined as the elderly subset) and 8092 donor corneas used for transplantation were obtained from the Australian Corneal Graft Register database. Kaplan-Meier graft survival plots were compared using log rank statistics.
RESULTS—Elderly recipients constituted 15% of the recipient pool. The major indication for corneal transplantation in the elderly was bullous keratopathy. Graft survival fell with increasing recipient age (p < 0.00001); the major cause of graft failure was rejection (33%). The desired outcome in 51% of cases was to improve vision and in 42% of cases to relieve pain; 23% of elderly recipients achieved a Snellen acuity of 6/18 or better in the grafted eye and 66% recorded improved acuity after transplantation. Elderly recipients suffered more complications and comorbidities in the grafted eye than did younger recipients. Donor age (stratified in 10 year intervals) did not influence corneal graft survival significantly (p = 0.10).
CONCLUSIONS—Elderly graft recipients fared less well after corneal transplantation than did younger recipients, but outcomes in terms of long term graft survival and visual rehabilitation were still good. Donor age did not affect graft survival.

     

Difficulty in performing everyday activities in patients with juvenile macular dystrophies: comparison with patients with retinitis pigmentosa

AIMS—To ascertain the level of perceived difficulty experienced by patients with central vision loss due to juvenile macular dystrophies in the performance of everyday activities. A second objective was to compare their perceived difficulty with that of patients with retinitis pigmentosa (RP) with primarily peripheral vision loss.
METHODS—72 patients with Stargardt disease, cone dystrophy, or cone-rod dystrophy who had visual acuities worse than 20/40 and normal peripheral visual fields rated themselves on their difficulty in the performance of 33 activities encompassing a wide variety of everyday tasks. These findings were compared with the responses of 120 patients with typical RP or Usher syndrome type 2 who had visual acuities of 20/40 or better and peripheral visual field loss.
RESULTS—The juvenile macular dystrophy group reported the greatest level of overall self perceived difficulty with activities involving central vision, and lesser and variable degrees of difficulty with items within the mobility, negotiating steps, driving, and miscellaneous categories. Consistent with these findings, there were highly significant correlations between subjects' rated performances of activities involving central vision and the clinical measures of vision, including visual acuity and size of central scotoma. There were fewer significant correlations between perceived performance of activities in the other categories and the clinical measures. In general, those activities that showed significant correlations with the clinical measures of vision for the patients with juvenile macular dystrophies also showed significant differences in the patterns of responses between the juvenile macular dystrophy group and the RP group. Those items which were not correlated with the clinical measures in the juvenile macular dystrophy group tended not to show significant differences in the response patterns between the two groups.
CONCLUSION—These results provide insight into the types of perceived difficulties in performing tasks of everyday life in patients with these disorders which affect counselling of these patients.

Keywords: vision; impairment; everyday activities; juvenile macular dystrophy     

Successful visual rehabilitation after neonatal penetrating keratoplasty

BACKGROUND—Penetrating keratoplasty in infancy and childhood has traditionally met with limited visual success due to a combination of unique physiology and technical problems in this patient population. With the advances in microsurgical instrumentation, corneal preservation, and visual developmental physiology ophthalmologists are finding increasing indications for penetrating keratoplasty in the childhood population. The long term results of neonatal penetrating keratoplasty in two patients with unilateral congenital corneal opacification are reported.
METHODS—Penetrating keratoplasty was performed on one eye in each of two infants within the first 3 weeks of life. Amblyopia treatment and optical therapy have been continued since surgery.
RESULTS—After 6 years both grafts have remained clear. One patient developed the infantile esotropia syndrome. Visual development using Snellen optotypes is age normal for both transplanted eyes.
CONCLUSIONS—Penetrating keratoplasty when combined with optical correction and amblyopia therapy may restore and preserve vision in selected patients with congenital corneal opacification if performed in the neonatal period.

     

Anterior capsular contraction after cataract surgery in eyes of diabetic patients

AIM—To investigate change in the area of anterior capsular opening (ACO) after cataract surgery and its relation to the degree of postoperative anterior inflammation in patients with diabetes mellitus (DM).
METHODS—31 eyes of 31 patients with DM and 30 eyes of 30 normal controls scheduled to undergo cataract surgery were examined prospectively. The area of ACO was measured with an anterior eye segment analysis system (EAS-1000) on the day following surgery and 3, 6, and 12 months after surgery. Comparative analyses were made on the area of ACO relative to the presence of DM and diabetic retinopathy (DR). The percentage reduction of area of ACO was calculated from values 1 day and 12 months after surgery, and multiple regression analysis was performed on the presence of DM, patient age, ACO area on the first postoperative day, and aqueous flare intensity 1 day and 12 months after surgery.
RESULTS—The area was significantly smaller in the DM group at 3 (p=0.015, Student's t test), 6 (p=0.011), and 12 (p=0.010) months postoperatively. Patients having DR showed significantly smaller ACO area than the non-DR group 3 (p=0.039), 6 (p=0.033), and 12 (p=0.028) months after surgery. Multiple regression analysis revealed that presence of DM (p=0.003) and aqueous flare intensity 12 months after surgery (p=0.039) significantly correlated with the percentage reduction of area of ACO. Age, ACO area at 1 day postoperatively, and aqueous flare intensity immediately after surgery were not relevant to ACO contraction.
CONCLUSIONS—Anterior capsular contraction after cataract surgery was greater in eyes of DM patients, especially in those with DR and increased permeability of the blood-aqueous barrier.

     

Movement hyperacuity in childhood amblyopia

BACKGROUND—Amblyopia results in deficits in a number of visual functions in both the amblyopic and dominant eye. The present work describes oscillatory movement displacement thresholds (OMDT) in childhood amblyopia.
METHODS—The OMDT from the dominant and amblyopic eyes of 50 orthoptic patients (aged 74 (SD 16) months) were compared with those from a group of 24 controls (79 (21) months). OMDT were measured using a forced choice staircase procedure. Subjects were asked to identify which of the computer controlled monitors displayed the oscillating stimulus. Visual acuity and stereoscopic responses were noted from clinical records.
RESULTS—Amblyopic children demonstrating stereopsis showed no significant OMDT deficit in the amblyopic eye. Those children having no stereopsis had elevated OMDT in the amblyopic eye (p<0.05). Results suggest that the dominant eye of children with amblyopia may also have a pattern of visual development which is anomalous (difference in correlation coefficient with age; p <0.05).
CONCLUSION—OMDT deficits demonstrated in some amblyopic eyes indicate that amblyopia is incompletely described by its "clinical" definition. Results suggest that the dominant eye in those with unilateral amblyopia may not be "normal".

Keywords: amblyopia; children; vision; movement hyperacuity; stereopsis     

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.

Keywords: intraocular lens; children; cataract; India