ORIGINAL ARTICLE

Purpose : Outcome of in-the-bag implanted square-edge polymethyl methacrylate intraocular lenses with and without primary posterior capsulotomy in pediatric traumatic cataract
IJO// Year : 2011 | Volume : 59 | Issue : 5 | Page : 347-351

Neelam Verma, Jagat Ram, Jaspreet Sukhija, Surinder S Pandav, Amit Gupta
Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012, India

Materials and Methods: The study was undertaken in a tertiary care center. Thirty eyes of 30 children ranging in age from 4 to 16 years with traumatic cataract which underwent cataract extraction with capsular bag implantation of IOL were prospectively evaluated.

Thirty children were randomized into two groups using random table.

y Group A comprised 15 eyes of 15 children unilateral traumatic

Group B comprised  15 eyes of 15 children with  unilateral traumatic

cataract who underwent cataract extraction with in-the-bag implantation of squareedge PMMA IOL with primary posterior capsulotomy (PPC) and anterior vitrectomy (AV)

cataract  in which the posterior capsule was left intact.

Patients were followed up for a minimum period of 12 months.

 Postoperative visual acuity, visual axis opacification (VAO)

and possible complications were analyzed.

Results: Best corrected visual acuity (BCVA) of 6/9 or better was achieved in 12 of 15 eyes in both groups.  Amblyopia was the cause of no improvement in visual acuity in the remaining eyes. Visual axis opacification was significantly high in Group B as compared to Group A. Postoperative fibrinous uveitis occurred in most of the eyes in both groups. Pupillary capture was observed in one eye in each group.

y Conclusion:

Primary posterior capsulotomy and anterior vitrectomy with capsular bag implantation of squareedge PMMA significantly helps to maintain a clear visual axis in children with traumatic cataract.

y Discussion :

The major management challenges for successful pediatric cataract surgery are
y aggressive postoperative inflammatory response, y secondary membrane formation in the visual axis and y the potential for developing severe vision-deprivation

amblyopia.

y This study shows that y a significant number of children with intact posterior

capsule may develop visually significant VAO even after placement of square-edge IOL in the capsular bag. y They found that performing PPC in pediatric traumatic cataract significantly reduced PCO and helped in maintaining clear visual axis. y This has special relevance to a developing country like India, where patients are likely to be lost to follow-up because of socioeconomic factors and the lack of adequate ophthalmic infrastructure.

Role of posterior capsulotomy with vitrectomy and IOL design and material in reducing PCO after pediatric cataract surgery.
J Cataract Refract Surg. 2003 Aug;29(8):1579-84. Ram J, Brar GS, Kaushik S, Gupta A, Gupta A.

y PURPOSE: To study the effect of primary posterior capsulotomy with anterior vitrectomy (PPC + AV) and IOL design and material on the development of PCO after pediatric cataract surgery. y CONCLUSIONS: It is the management of the posterior capsule rather than IOL design and material that influences the incidence of PCO after cataract surgery in children. Development of PCO in the postoperative period was delayed with a hydrophobic acrylic IOL with square edges compared with a PMMA lens without square edges.

Results and complications of hydrophobic acrylic vs PMMA posterior chamber lenses in children under 17 years of age. Graefes Arch Clin Exp Ophthalmol.
2003 Aug;241(8):637-41. Epub 2003 Jul 17. Kchle M, Lausen B, Gusek-Schneider GC.

y PURPOSE:

To compare results and complications of implantation of hydrophobic acrylic foldable IOL in children with those of PMMA IOL.
y CONCLUSIONS: Implantation of hydrophobic acrylic IOL in the capsular bag in children may be associated with less postoperative complications compared to implantation of PMMA lenses.. The visual results seem comparable and correspond mainly to the underlying ocular pathology.

Original Article Square-edge PMMA IOL design for reducing PCO following paediatric cataract surgery: initial experience
y Clinical and Experimental Ophthalmology y 2008; 36: 625 630
y Gagandeep S Brar MD,Dilraj S Grewal MD,Jagat Ram MD,Mohit Singla MD and Satinder Pal S Grewal MD

Purpose:

To compare the incidence and severity of development of PCO following implantation of square-edged PMMA or hydrophobic acrylic IOLs following paediatric cataract surgery.
y Conclusions:

Square-edge PMMA IOLs offer a signi cant cost advantage over acrylic lenses at similar rates of PCO formation following paediatric cataract surgery, which is of signi cant value in developing countries. It is the square-edge IOL design rather than the IOL material that in uences the incidence of PCO.

Unilateral Scleral Fixation of Posterior Chamber Intraocular Lenses in Pediatric Complicated Traumatic Cataracts
Korean J Ophthalmol. 2009 September; 23(3): 148 152. Dong Won Hyun, MD,1 Tae-Gon Lee, MD, 1 and Sung Won Cho, MD, PhD2

y Purpose :

The purpose of this study was to evaluate the visual outcomes and complications of unilateral scleral fixation of posterior chamber intraocular lenses (SF-PCIOLs) in pediatric complicated traumatic cataracts without capsular support.
y Conclusions :

Unilateral scleral fixation of PCIOL can be a safe and effective procedure for pediatric, unilateral, complicated traumatic cataracts without capsular support in selected cases.

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