Intraocular lens implantation in traumatic cataract

PURPOSE: The evaluation of postoperative results and complications after traumatic cataract extraction with intraocular lens implantation. MATERIAL AND METHODS: Forty two eyes of 41 patients (31 male and 10 female) aged from 10 to 66 years (mean 37.8) with traumatic cataract were the subject of our study. They were operated on between 1996 and 1997. A penetrating injury in 33 eyes (78.6%) and blunt trauma in 9 eyes (21.4%) caused the cataract. The interval between trauma and cataract surgery ranged from 1 day to 40 years. The mean follow up was 13.5 months. Despite of cataract corneal scars, pupil deformations, posterior and anterior synechiae were observed in most of the eyes. Extracapsular cataract extraction was performed in all cases. Posterior chamber IOLs were implanted in 33 eyes. Anterior vitrectomy and anterior chamber IOL implantation was performed in 9 eyes due to the lack of capsular support. RESULTS: Very good or good visual acuity (5/5-5/16) was achieved in 71.4% of cases. Low visual acuity (below 5/50) was observed in 6 eyes (14.3%) because of severe damage to the retina, optic nerve atrophy or amblyopia. Fibrin reaction in anterior chamber (30.9%), hyphaema (19%) and haemophtalmus (4.8%) were the most severe postoperative complications. CONCLUSIONS: An intraocular lens implantation in traumatic cataract, despite many postoperative complications, enables most of the patients to achieve satisfactory and useful vision. Patients with severe posterior segment damage do not benefit functionally from cataract surgery.     

Long-term results after epilenticular intraocular lens implantation following traumatic cataract

BACKGROUND: The purpose of this study was to analyze the late postoperative outcome and complication rate after lensectomy with primary epilenticular intraocular lens (IOL) implantation for traumatic cataract. Material and Methods: We retrospectively reviewed the data of 11 patients who were operated on for traumatic cataract after penetrating or blunt ocular trauma between 1997 and 2002. One patient developed cataract due to a large rupture of the posterior capsule after blunt trauma. Ten patients sustained a penetrating ocular injury with (7 eyes) or without (3 eyes) intraocular foreign body (IOFB). In all patients the IOL was implanted at the beginning of the operation into the ciliary sulcus in front of the opaque lens followed by pars-plana lensectomy and vitrectomy. RESULTS: The mean follow-up was 27.4 months. Eight eyes (72.7 %) achieved a final visual acuity of 0.5 or better. Major causes of limited visual acuity were central corneal scars causing irregular astigmatism. In all patients the IOL was safely and easily implanted into the ciliary sulcus. During the subsequent pars-plana lensectomy and vitrectomy as well as during the follow-up period all IOLs remained anatomically stable and well centered. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Epilenticular IOL implantation followed by pars-plana lensectomy is an easy and safe method to treat traumatic cataract in the setting of penetrating ocular trauma repair. It is associated with a favorable visual outcome and a low rate of postoperative complications.     

Secondary intraocular lens implantation of traumatic cataract in open-globe injury

BACKGROUND: The purpose of this study was to determine the visual outcome and accuracy of biometry in traumatic cataract in open-globe injury. METHODS: A clinical retrospective study of 30 consecutive patients treated for ocular penetrating trauma was conducted. Patient demographics, causes of injury, wound categories, timing and procedures of the primary repair, interval of subsequent intraocular lens (IOL) implantation, follow-up, and postoperative complications were recorded. Additionally, binocular biometry was documented. Twenty-six eyes (86.7%) were open-globe injuries occurring in the workplace. All patients received cataract extraction with primary repair of the penetrating wound, 18 eyes (60%) underwent trans pars plana vitrectomy with lensectomy and 12 eyes (40%) underwent lens aspiration or extracapsular cataract extraction. Simultaneously, 16 eyes (53.3%) underwent intraocular foreign body removal. RESULTS: The mean visual improvement after secondary IOL implantation was statistically significant (p = 0.002). Seventeen eyes (56.7%) achieved final best-corrected visual acuity of 20/40 or better. The mean deviation of final refraction and target refraction was -0.69 +/- 0.56 diopter, and 23 eyes (76.7%) were within 1 diopter based on biometry of the traumatic eye. In 18 eyes (60%), the difference was within 1 diopter according to biometry of the fellow eye. In 5 cases (16.7%), there was no improvement of vision because of central corneal scar, secondary glaucoma, macular pucker, or recurrent retinal detachment. INTERPRETATION: The vision of patients with traumatic cataract in open-globe injury was improved after prompt surgical intervention and subsequent IOL implantation. A minority of patients experienced no change in vision or a deterioration of vision due to irregular astigmatism caused by a corneal wound or variable damage to the posterior segment. Using biometry of the injured eye after primary repair was more accurate than using biometry of the fellow eye to determine the power of the lens for IOL implantation in variable open-globe injury.     

后囊破裂的外伤性白内障手术治疗

目的 探讨角膜穿孔伤伴后囊破裂的外伤性白内障手术时机、手术处理技巧和人工晶状体植入方法与原则.方法 角膜穿孔伤伴后囊破裂的外伤性白内障53例（53眼）,伤后4～11天,根据囊破裂、玻璃体视网膜等后段紊乱程度选择单纯超声乳化、晶状体皮质吸取,品状体切除联合玻璃体切除术处理后段紊乩,其中39眼（73.59%）一期植入人工晶状体,12眼（22.64%）二期植入人工晶状体.结果 术后6月矫正视力：低于0.1者3眼（5.66%）,0.1～0.25者13眼（24.53%）,0.3～0.6者28眼（52.83%）,大于0.6者9眼（16.98%）.人工晶状体偏位3眼,人工晶状体夹持2眼,人工晶状体脱位1眼.结论 角膜穿孔伤伴后囊破裂的外伤性白内障伤后应及早手术,并根据其眼前段紊乱的程度及是否伴有眼后段组织严重损害,选择适当的手术方式并适时植入人工晶状体.     

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.     

角膜穿孔伤并白内障人工晶状体植入临床观察

目的探讨角膜穿孔伤合并外伤性白内障患者，人工晶状体植入联合手术方法及效果。方法对32例（32眼）角膜穿孔伤合并外伤性白内障施行的囊外摘出联合人工晶状体植入术进行回顾性分析。13眼采用Ⅰ期角膜缝合联合白内障囊外摘出联合人工晶状体植入术。19眼采用Ⅱ期白内障囊外摘出联合人工晶状体植入术。结果术后随访1-3月，视力≥1．0者4眼，占12．50％；0．5-0．9者19眼，占59．38％；0．1-0．4者6眼，占18．75％；0．1以下者3眼，占9．38％。结论角膜缝合，晶状体摘出和人工晶状体植入三联合手术的手术时机及术式的选择非常重要，同时须对术中、术后并发症采取合理的治疗措施。     

Electrical cataract: a case study

A case of bilateral cataract sustained after electrical trauma was seen in a referral practice. We examined a young patient with dense anterior and posterior subcapsular cataract in his right eye and pseudophakia in his left eye who gave a history of gradually progressive painless loss of vision after sustaining injury from a high voltage electric current. Extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation was performed in his right eye. Visual rehabilitation in both eyes after ECCE with PCIOL implantation was good with the patient attaining uncorrected visual acuity of 20/30 in both eyes postoperatively. It appears that the surgical results and visual rehabilitation after ECCE with PCIOL implantation in patients with electrical cataract without any other ocular damage is excellent.     

儿童角膜穿孔伤三联手术疗效观察

目的　观察小儿角膜穿孔外伤性白内障超声乳化联合术的疗效。方法　对 6 8例 (6 8只眼 )角膜穿孔合并外伤性白内障患者 ,施行角膜穿孔伤清创缝合、超声乳化摘出白内障、后房型人工晶状体植入三联手术 (A组 )。并与同期和既往 5 7例 (5 7只眼 )同类病例行角膜伤口修补、白内障现代囊外摘出及人工晶状体植入术 (B组 )作对比。术后随访 1～ 2年。结果　术后 2周视力≥ 0 .5者 ,A组为 2 7只眼 ,B组为 12只眼。两组间差异有显著性(P <0 .0 5 )。术后并发症 A组较 B组明显减少 ,尤其是术后 1年后囊混浊的发生前者仅为 15只眼 ,后者为 2 5只眼(P <0 .0 1)。结论　此术式对眼组织损伤轻 ,术后视力恢复快 ,并发症少 ,是目前治疗小儿角膜穿孔合并外伤性白内障的最理想方法     

Pediatric cataract surgery in Nepal

PURPOSE: To describe the first pediatric cataract surgery case series report from Nepal. SETTING: Tilganga Eye Center, Kathmandu, Nepal. METHODS: This study comprised a consecutive series of 112 eyes of 85 children having cataract surgery with intraocular lens (IOL) implantation. General anesthesia of ketamine combined with peribulbar block was used in all patients. Patients' demographics, cataract type and presenting symptoms, surgical intervention, preoperative and postoperative visual acuities, and follow-up clinical examinations were recorded. RESULTS: Seventy-three eyes (65.2%) of 53 patients had extracapsular cataract extraction with posterior capsulotomy, anterior vitrectomy, and posterior chamber IOL implantation (ECCE+PCAP+AV+PCIOL), and 39 eyes (34.8%) of 32 patients had cataract extraction and IOL implantation with an intact posterior capsule (ECCE+PCIOL). Of all patients, the mean age at surgery was 6.2 years +/- 4.3 (SD). The median age in the ECCE+PCAP+AV+PCIOL group was 4.7 years and in the ECCE+PCIOL group, 11.0 years. The mean follow-up was 5.4 +/- 5.3 months. The most common postoperative complication in the ECCE+PCIOL group was visual axis/posterior capsule opacification, which was seen in 18 eyes (46.2%) compared to 4 eyes (5.5%) in the ECCE+PCAP+AV+PCIOL group. Visual acuity improved with surgery in both groups. The leading cause of poor outcomes was deprivation amblyopia. There were no anesthesia-related complications. CONCLUSIONS: Implantation of an IOL at the time of cataract extraction under combined systemic ketamine and peribulbar lidocaine anesthesia appeared to be well tolerated and produced significant visual improvement in pediatric patients in Nepal. Primary posterior capsulotomy and AV helped prevent visual axis opacification without a significant increase in complications.     

Combined lensectomy,vitrectomy, and primary intraocular lens implantation in patients with traumatic eye injury

Purpose To analyse the postoperative anatomic and functional outcomes in addition to complications after combined lensectomy, vitrectomy, and primary intraocular lens (IOL) implantation in patients with traumatic eye injury. Methods Retrospective review of patients with traumatic cataract and posterior segment injury who underwent combined lensectomy, vitrectomy, and primary IOL implantation with a minimum follow up (FU) of 3 months. Results Thirteen consecutive patients (all male) with a mean age of 42.8 years (range 17–82 years) underwent combined lensectomy, vitrectomy, and primary IOL implantation from February 2000 to January 2006. Postoperative FU ranged from 3 to 54 months (mean 17.6 months). Best corrected visual acuity (BCVA) at presentation ranged from 20/30 to hand movement and was worse than 20/200 in eight patients (61%). Four patients (31%) had blunt trauma with no globe rupture. Of the nine patients (69%) with a penetrating eye injury (PEI), eight had an intraocular foreign body (IOFB) with one retinal detachment at presentation. Four patients had primary closure at the time of the vitrectomy. All eight IOFBs were removed. Seven patients had additional scleral buckling and four intravitreal gas injection. BCVA at last FU ranged from 20/20 to 20/300 and was 20/40 or better in eight eyes (62%). All patients had an attached retina at last FU. One eye had further surgery for epiretinal membrane proliferation and ptosis. Conclusions These results suggest that combined vitrectomy, lensectomy and primary intraocular implantation can offer good visual rehabilitation in patients with traumatic cataract and posterior segment injury.     

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

PURPOSE: To evaluate the visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses (IOLs) for traumatic cataracts in children. SETTING: Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: Twenty children (20 eyes) with traumatic cataracts had extracapsular cataract extraction (ECCE) and posterior chamber IOL implantation. They were randomly divided into 2 groups. Capsular bag fixation was performed in 10 children (Group A) and ciliary sulcus fixation in the other 10 (Group B). Traumatic cataracts associated with large corneal lacerations (10.0 mm or more), hyphema, angle recession, or posterior segment involvement were excluded. The best corrected visual acuity (BCVA) as well as early and delayed postoperative complications were prospectively evaluated in both groups. RESULTS: The BCVA was 6/12 or better in 9 eyes (90%) in Group A and 8 eyes (80%) in Group B at the end of the mean follow-up (24.6 months +/- 10.6 [SD]). Amblyopia (1 eye in Group A) and corneal scar and commotio retinae (1 eye each in Group B) accounted for a visual acuity of worse than 6/12. The residual refractive error did not exceed 3.50 diopters in either group. The incidences of fibrinous anterior uveitis and pupillary capture were significantly higher in Group B (P < .05, Fisher exact test). CONCLUSION: Capsular bag fixation of posterior chamber IOLs provided visual results similar to those with ciliary sulcus fixation but was associated with fewer postoperative complications, particularly uveitis and pupillary capture. This represents another important reason to attempt in-the-bag fixation in cases of traumatic cataract.     

开放性眼外伤致外伤性白内障的二期人工晶状体植入术15例回顾分析

目的:分析开放性眼外伤二期人工晶状体(intraocular lens,IOL)植入术后的视力、早期并发症及屈光偏差.方法:回顾性分析2004/2005年15例开放性眼外伤引起角巩膜撕裂的外伤性白内障患者,一期行白内障摘除及开放性眼外伤修复术,二期进行IOL植入术.主要记录患者最佳矫正视力,早期并发症及屈光偏差.结果:两次手术时间间隔平均为2.57mo,最佳矫正视力,13例(87%)矫正视力在0.5或以上,所有眼最佳矫正视力均在0.3或以上.手术早期并发症包括角膜水肿、轻度至中度虹膜睫状体炎、黄斑水肿、黄斑皱褶等.术后视力的改善受限于因角膜中央或旁中央疤痕所致的不规则散光及发展的黄斑皱褶.最后的屈光状态,11眼(73%)屈光在1D内,屈光正常,4眼(27%)屈光在1～3 D.结论:开放性眼外伤二期植入IOL是安全的.应用受伤眼生物学数据计算IOL度数,二期植入IOL对于开放性眼外伤引起的外伤性白内障,获得理想的矫正视力有益.     

Transsclerally fixated intraocular lenses in children

BACKGROUND AND OBJECTIVE: To evaluate the visual outcome and complications of transsclerally fixated intraocular lenses (IOLs) in children without sufficient capsular support. PATIENTS AND METHODS: Twenty-one aphakic eyes of 18 children (13 boys and 5 girls) who underwent secondary transscleral IOL fixation were evaluated retrospectively. Ten eyes with aphakia after infantile cataract surgery, 7 aphakic eyes following traumatic cataract surgery, and 4 eyes after ectopia lentis surgery received secondary transscleral posterior chamber IOL fixation because of by insufficient posterior capsular support. Visual outcomes and postoperative complications were recorded. RESULTS: After a mean follow up of 22.5 months (range, 12 to 36 months), visual improvement of more than 2 Snellen lines was observed in 9 eyes (42.8 %). Preoperative visual acuity could not be assessed in 7 eyes (33.3%) because of associated neurological and developmental disorders. One eye (4.7%) lost 2 Snellen lines of the best corrected visual acuity because of concurrent endophthalmitis and retinal detachment. Pupillary distortion, transient pupillary membrane, pupillary capture as well as strabismus and anterior uveitis, were the most common complications. Endophthalmitis and retinal detachment were the most severe postoperative complications. CONCLUSION: Transsclerally fixated IOL implantation may be visually rewarding in well selected pediatric cases, but the potential complications would suggest extreme caution in its consideration. Until long-term studies are published, it is difficult to recommend implantation unless it is deemed impossible to provide adequate rehabilitation by other means such as contact lenses or aphakic spectacles.     

Traumatic pediatric cataract: A decade of follow-up after Artisan aphakia intraocular lens implantation

PURPOSE: To describe the long-term clinical outcome of Artisan((R)) aphakia intraocular lens (IOL; Ophtec, Groningen, The Netherlands) implantation in five aphakic eyes of five children, without capsular support, after cataract extraction following penetrating ocular trauma. METHODS: The charts of the five children were retrospectively reviewed. The data collected included follow-up time, nature of injury, age at cataract extraction and IOL implantation, visual outcome, endothelial cell counts, complications, and subsequent surgical interventions. RESULTS: Average follow-up was 11.0 years (range, 8.0-14.6 years). All eyes had a corneal perforation with various degrees of anterior segment injury. Mean patient age at lens extraction was 7.8 years (range, 5.6-10.2 years). Mean age at Artisan aphakia IOL implantation was 7.9 years (range, 5.7-10.2 years). The best spectacle-corrected visual acuity at last follow-up was 20/40 or better in four eyes. Mean endothelial cell loss compared with the healthy fellow eye was 40%. No patients experienced IOL dislocation, corneal decompensation, chronic anterior uveitis, cystoid macular edema, or iris atrophy. One eye had a retinal detachment 19 months after primary injury and needed vitreoretinal surgery. CONCLUSIONS: The Artisan aphakia IOL offers a useful alternative for correction of traumatic childhood aphakia. Although we only have results of a small number of patients, taking into account our long follow-up period, we feel that implantation of the Artisan aphakia IOL can be considered a treatment option in aphakic eyes of children that lack capsular support due to trauma.     

When may the posterior capsule be preserved in pediatric intraocular lens surgery?

PURPOSE: To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamber intraocular lens (PCIOL) implantation for cataract in childhood. DESIGN: Noncomparative case series. PARTICIPANTS: Patients 1 to 13 years old who underwent cataract extraction with intent to preserve the posterior lens capsule and PCIOL implantation between January 1992 and December 1998 at a pediatric hospital. METHODS: Medical records were reviewed to determine the frequency and timing of posterior capsule opacification (PCO) after PCIOL surgery with preservation of an intact posterior capsule. Comparison of pseudophakic PCO rates for groups defined by age and several possible risk factors. Assessment of safety and efficacy for PPC with anterior vitrectomy performed through a limbal incision in cases where the posterior capsule could not be preserved. MAIN OUTCOME MEASURES: Need for neodymium:yttrium-aluminum-garnet laser capsulotomy or surgical membranectomy to treat PCO. RESULTS: PCO occurred in 40% of 30 eyes with intact posterior capsule. Mean follow-up duration was 22 months for eyes that had PCO develop and 24 months for those in which the posterior capsule remained clear. Laser capsulotomy was required for 64% of 14 eyes in the 1- to 6-year-old age range but for only 19% of 16 in the 6- to 13-year-old range (P < 0.05). Mean time from surgery to PCO was 7 months for the younger group and 13 months for the older group. A need for repeated capsulotomy (one eye) or membranectomy with anterior vitrectomy (two eyes) was found only in the younger age group. There was no association of PCO with trauma history, cataract type, residual lens cortex, IOL position, or postoperative fibrin clot. Final vision was possibly compromised as a result of PCO in one eye with amblyopia. None of 24 eyes in which PPC with anterior vitrectomy was performed out of intraoperative necessity before primary PCIOL implantation had secondary opacification develop. No reduction in postoperative vision was attributable to PPC. CONCLUSIONS: PPC seems to be advisable for children less than 6 years old when cataract extraction with PCIOL implantation is performed. Preservation of the posterior capsule remains appropriate for older children with pseudophakia.     

复杂眼球穿孔伤人工晶状体植入的类型和时机

目的 探讨复杂眼球穿孔伤植人人工晶状体(IOL)的类型和时机选择。方法 对78例(78眼)复杂眼球穿孔伤致外伤性白内障及玻璃体视网膜病变的患者行玻璃体切除联合Ⅰ期IOL植入术(12例)、Ⅱ期前房型IOL(57例)及虹膜隔IOL植入术(9例)。术后随访6—36月，平均12.8月。结果 术后视力均较术前明显提高，视力预后与眼后段损伤程度密切相关。无一例发生视网膜脱离或角膜内皮功能失代偿。结论 复杂眼球穿孔伤植入IOL应建立在具有良好视功能的基础上，不要盲目追求Ⅰ期植入。对于无视网膜脱离或化脓性眼内炎者可Ⅰ期植入，否则均应Ⅱ期植入。晶状体囊保留者可选择后房型IOL囊缺失者可选择前房型IOL；伴外伤性无虹膜者则建议选择虹膜隔IOL。     

Epilenticular intraocular lens implantation in traumatic cataract with a ruptured posterior capsule

PURPOSE: To present a case of rapidly progressing traumatic cataract caused by posterior capsule rupture after nonpenetrating ocular injury, as well as a surgical procedure to safely implant the intraocular lens in such a traumatized eye. METHODS: In a 23-year-old man with traumatic cataract and posterior lens capsule rupture, a one-piece polymethylmethacrylate IOL was implanted before cataract extraction into the ciliary sulcus in front of the cataractous lens. Subsequently, the cataract was removed by pars plana lensectomy. RESULTS: The surgery and postoperative course were uneventful. Postoperative visual acuity was 20/20. CONCLUSION: We present a method of intraocular lens implantation in cases of rapidly progressing traumatic cataract caused by posterior capsule rupture after a blunt ocular trauma.     

Combined lensectomy, vitrectomy and scleral fixation of intraocular lens implant after closed-globe injury.

PURPOSE: To describe our experience in the surgical management of cataracts in patients with complications of closed-globe injury using pars plana lensectomy (PPL), pars plana vitrectomy (PPV), and scleral fixation of posterior chamber intraocular lens (PCIOL). METHODS: We retrospectively reviewed charts of all patients with closed-globe injury who underwent PPL, PPV and scleral fixation of PCIOL at our institution between January 1991 and July 1997. We identified 28 eyes; because of less than 2 weeks follow-up, 4 eyes were excluded from the current study. All eyes had lens subluxation/dislocation and visually significant cataract. Additional indications for surgery included secondary glaucoma (10 eyes), vitreous hemorrhage (3 eyes) and retinal detachment (1 eye). RESULTS: The postoperative follow-up interval ranged from 6 to 61 months (mean 18.5 months). Preoperative visual acuity (VA) ranged from 20/60 to hand motion and was 20/100 or better in 6 eyes (25%). Postoperatively, 19 eyes (79%) improved to 20/100 or better. Five eyes had subsequent surgery for the following indications: retinal detachment (2 eyes), poorly controlled glaucoma (2 eyes), and epiretinal membrane formation (1 eye). CONCLUSIONS: In patients undergoing PPL, PPV and scleral fixation of PCIOL for cataract after a closed-globe injury, a substantial visual improvement occurred in a majority of the involved eyes.     

Visual function after implantation of aniridia intraocular lens for traumatic aniridia in vitrectomized eye

PURPOSE: To evaluate the efficacy and safety of aniridia posterior chamber intraocular lens (PCIOL) in traumatic aniridia and aphakia in vitrectomized eyes. METHODS: Four aphakic patients with traumatic aniridia and previous pars plana vitrectomy (PPV) due to posterior segment trauma enrolled in the study, and had secondary implantation of an aniridia PCIOL. Two patients were men and two women with mean age of 39.25 years. Complete ophthalmic examinations, including preoperative and postoperative visual acuity in dark and light, glare disability, visual function (using VF-9 questions modified from VF-14), stereopsis, and contrast sensitivity in 3, 6, 12, and 18 cycle per degree frequencies, were done for all patients. Postoperative intraocular pressure (IOP), IOL centration, and intraocular inflammation were monitored. Mean follow-up was 12.25 months (range 7 to 15 months). RESULTS: Visual acuity improved in all four patients, especially in the light. Glare was subjectively reduced in all of them. Stereopsis was measurable in three of them postoperatively. Contrast sensitivity improved in all patients, especially in brightness and lower frequencies. All four eyes had improved VF-9. All eyes achieved the desired anatomic results. Two cases developed elevated IOP early after surgery. In one eye, IOP elevation was transient and controlled with antiglaucoma medication, but the other eye, which had secondary glaucoma from previous trauma, required cyclophotocoagulation for the IOP to be controlled. No patient developed chronic uveitis or redetachment. CONCLUSIONS: The aniridia PCIOL can overcome aphakia, reduce glare, and increase visual function, contrast sensitivity, and stereopsis in vitrectomized eyes with traumatic aniridia. Although this kind of IOL appears safe, some disadvantages are secondary glaucoma and reduced visibility of peripheral fundus, and caution should be used in its implantation until more patients with longer follow-up are studied.     

Stereopsis after primary in-the-bag posterior chamber implantation in children.

PURPOSE: The purpose of this study was to evaluate visual acuity and binocular function after primary posterior chamber intraocular lens (IOL) implantation in children. PATIENTS AND METHODS: A retrospective chart review of 39 eyes of 31 children was performed. Fifteen eyes with traumatic, 17 with developmental, and 7 with congenital cataracts without any other ophthalmologic problems were examined before and after cataract surgery (irrigation/aspiration procedure with implantation of a posterior chamber IOL). Twelve eyes also received a posterior capsulorrhexis and anterior vitrectomy. The mean age at surgery was 6.9 +/- 3 years (range, 3-12 years). RESULTS: Twenty (51%) of 39 eyes achieved a best-corrected postoperative visual acuity of 20/40 or better (range, 20/200-20/20). The mean postoperative visual acuity was 20/40 in the traumatic and developmental cataract groups and 20/100 in the congenital cataract group. There was a positive correlation between cataract morphology and visual acuity (P<.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (P <.005). Nineteen (70%) of 27 eyes in which no primary posterior capsulorrhexis had been performed had posterior capsule opacification. Stereopsis was found in 10 of the 31 patients: 43% of the traumatic cataract group, 30% of the developmental cataract group, and 14% of the congenital cataract group. CONCLUSIONS: After capsular bag-fixated IOL, visual acuity and binocular function in children older than 3 years were favorable and the complication rate, excluding posterior capsule opacification, was low.