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Factors affecting visual outcome in children following uniocular traumatic cataract
A J Churchill1, B A Noble, D E Etchells
1Ophthalmology Department, General Infirmary at Leeds, West Yorkshire, UK.
Insights
Treating paediatric traumatic cataracts with intraocular lens implants or contact lenses yields good visual outcomes. Early lens implantation is recommended for children to maximize vision and stereopsis.
Area of Science:
- Ophthalmology
- Paediatric Surgery
- Trauma Care
Background:
- Paediatric traumatic aphakia correction is debated.
- Uniocular traumatic cataracts in children present unique challenges.
Purpose of the Study:
- To compare visual outcomes in children with traumatic cataracts treated with intraocular lens implants versus contact lenses.
- To identify factors influencing visual results in paediatric traumatic aphakia.
Main Methods:
- Retrospective study of 32 children (aged 2-14.5 years) with uniocular traumatic cataracts.
- Comparison of outcomes between 15 patients receiving intraocular lens implants post-lensectomy and 17 patients fitted with aphakic contact lenses.
- Maximum follow-up of 13 years.
Main Results:
- 24 children achieved good visual acuity (6/5 to 6/18), with equal distribution between intraocular lens and contact lens groups.
- Factors negatively impacting vision included complex trauma, delayed surgery, and poor postoperative correction.
- Contact lens issues and occlusion therapy problems were also noted.
Conclusions:
- Early lensectomy and intraocular lens implantation are advised for traumatic cataracts in children.
- This approach mitigates contact lens complications and enhances the potential for good vision and stereopsis.
- While intraocular lens implants may necessitate further procedures like capsulotomy, they offer superior long-term visual benefits.
Abstract:
The correction of paediatric traumatic aphakia remains a controversial topic. This study examines retrospectively the visual outcome in 32 children with uniocular traumatic cataracts. Fifteen received intraocular lens implants following lensectomy, and 17 received aphakic contact lenses. Age range was 2-14 1/2 years at the time of injury. The maximum follow-up time was 13 years. Twenty-four children obtained a good visual result (6/5 to 6/18). These were equally divided between those receiving intraocular lens implants and those with contact lenses. Factors adversely affecting visual outcome are discussed. These include complex trauma, delay in referral for lensectomy, inadequate postoperative correction of aphakia, contact lens difficulties and problems with occlusion therapy. Although aphakic correction with intraocular lens implants may require several subsequent surgical procedures such as capsulotomy, we advise early lensectomy and intraocular lens implantation where possible, particularly in young children with traumatic cataracts. This eliminates contact-lens-associated problems and maximises the chance of good visual outcome and retention of stereoscopic vision.