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Implantation in children
H V Gimbel1, M Ferensowicz, M Raanan
1Gimbel Eye Centre, Calgary, Alberta, Canada.
Insights
Posterior chamber intraocular lens (IOL) implantation in children is safe and effective, with minimal complications and good visual outcomes. Most pediatric patients achieved significant visual improvement after cataract surgery with IOLs.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Advancements in surgical techniques and materials have increased the use of intraocular lenses (IOLs) in pediatric cataract cases.
- Posterior chamber IOLs (PC-IOLs) are increasingly favored for implantation in the capsular bag.
Purpose of the Study:
- To evaluate the safety and efficacy of PC-IOL implantation in pediatric patients with various types of cataracts.
- To assess visual outcomes and complications associated with pediatric IOL surgery.
Main Methods:
- A retrospective review of 61 eyes in 46 children and adolescents who underwent cataract extraction and PC-IOL implantation between 1982 and the study period.
- Surgical technique involved in-the-bag placement using small capsulectomy and, from 1984, continuous curvilinear capsulorhexis.
- Patient cohort divided into preschool (2-5 years), child (6-12 years), and adolescent (13-18 years) age groups.
Main Results:
- Congenital cataracts were most common (44 eyes), followed by traumatic (13 eyes) and developmental (4 eyes).
- Overall, 79% of the total cohort achieved a best-corrected visual acuity of 20/40 or better.
- Visual acuity outcomes varied by age group, with 56% of preschoolers, 87% of children, and 86% of adolescents reaching 20/40 or better.
- Thirty-five percent achieved uncorrected visual acuity of 20/40 or better, and 48% were within 1 diopter of emmetropia.
- Improvement in best-corrected vision was observed in all but two cases, with deprivation amblyopia being the primary cause of unachieved 20/20 vision.
Conclusions:
- Posterior chamber IOL implantation in the capsular bag is a safe and effective procedure for pediatric cataract patients.
- The study demonstrates good visual results and minimal complications, supporting the use of IOLs in children and adolescents.
- Deprivation amblyopia remains a significant factor influencing final visual acuity in pediatric pseudophakia.
Abstract:
With the development of posterior chamber lenses and continuous curvilinear capsulorhexis, and with the availability of viscoelastic agents, the use of intraocular lenses (IOLs) in children is becoming more popular. Since 1982, we have implanted posterior chamber IOLs (PC-IOLs) in the capsular bags of 61 cataractous eyes of 46 children and adolescents. The goal was in-the-bag placement facilitated by the use of a small capsulectomy, and, since 1984, by the use of the continuous curvilinear capsulorhexis. Forty-four cataracts were congenital, 13 were traumatic, and 4 were developmental. Cataract extraction with IOL implantation was performed in 16 (26%) preschool cases (ages 2 through 5), in 31 (51%) child cases (ages 6 through 12), and 14 (23%) adolescent cases (ages 13 through 18). Surgical and postoperative complications were minimal. Visual results were good. Fifty-six percent of preschoolers, 87% of children, and 86% of adolescents achieved 20/40 or better best corrected vision, with 79% of the total cohort achieving 20/40 or better. Overall, 35% achieved an uncorrected visual acuity of 20/40 or better. All but two cases had improvement in best corrected vision; if 20/20 was not attained, the cause was mainly due to deprivation amblyopia. Forty-eight percent of patients were within a diopter of emmetropia.