[Intraocular lens implantation in severely mentally and physically handicapped patients]

We implanted a posterior chamber intraocular lens (PC-IOL) in 30 eyes of 17 severely mentally and physically handicapped patients, i.e., 14 eyes of 9 severely mentally retarded patients, 14 eyes of 7 patients with Down's syndrome, and 2 eyes of a mitochondrial encephalomyopathy patient. All surgery was performed under general anesthesia and 3 to 10 post-operative days of hospital care were needed in an ophthalmic ward. A post-operative intensive care unit was not necessary. Severe post-operative complications occurred in 2 eyes of 2 cases. One case was complicated by an iris prolapse, and in another case traumatic wound rupture caused a prolapse of the IOL, vitreous, and retina. However, in both cases, the other eye, which also had a PC-IOL implantation, showed an uneventful post-operative course. Vision and quality of life in all patients seem to have improved. The present observations indicate that cataract surgery with PC-IOL for these patients should be positively considered in spite of difficulties in pre- and post-operative management, and when done, calibration of IOL power immediately before surgery under general anesthesia and small incision techniques are essential.