Intraocular lens implantation in children with monocular cataracts. 1974-1983

Two hundred twenty-five consecutive intraocular lens (IOL) implants performed by the same surgeon from 1977 to 1983 are reviewed. Ninety (40%) patients had traumatic cataracts and 135 (60%) patients had infantile cataracts. Fifty-four percent of the patients presented with preoperative complications. The most frequent were corneal scars (62%) in the traumatic cataract patients, and posterior lenticonus (18%), microphthalmia (16%), PHPV (14%), and optic nerve defects (12%) in the infantile cataract patients. The iris suture lens was implanted from 1973 to 1982, but the posterior chamber lens is now the most frequently implanted primary IOL. Flexible anterior chamber or iris suture IOLs are used as secondary implants. Follow-up ranged from six months to nine years. Postoperatively, 66% of the patients required spectacles for residual optical correction and 55% required occlusion for amblyopia. Postoperative complications consisted of post-pseudophakos membranes (13%), peripheral iris erosion (13%), iris sphincter erosion (18%), dislocated IOLs (7%) and corneal edema (4%). Secondary surgical procedures relating to the IOL were discissions of post-pseudophakos membranes (6 patients), refixation of dislocated lens (15 patients) and IOL removal (6 patients). The best corrected visual acuities during the course of the follow-up was 20/20 to 20/40 in 34% of the patients, 20/50 to 20/100 in 21%, 20/200 in 12%, and less than 20/200 in 33% of patients. Sixty percent of the traumatic cataract patients achieved 20/20 to 20/40 acuity and 17% of the infantile cataract patients achieved this level. Primary implantation patients achieved superior acuities over secondary implantations in both groups.