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Cataract Surgery and IOL Implantation in Children


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Out of 24 patients, 25 eyes had congenital or developmental cataracts, 5 were from accidental trauma out of which 2 eyes had penetrating injury (Fig 1), and 3 eyes had history of blunt injury.

In 2 eyes the posterior capsule was ruptured during cataract removal in the ECCE group, necessitating anterior vitrectomy and sulcus fixation of the posterior chamber lenses. Two patients had primary fibrosis of posterior capsule and plaques for which posterior rhexis was performed.

Table 2 – Visual Outcome

Visual acuity No. Percentage
6/6-6/12 15 50
<6/18-6/60 12 40
<6/60-3/60 2 6.66
<3/60 1 3.33
Total 30 ?

Ninety percentage of children achieved a binocular acuity of 6/60 or better. There is almost negligible difference in visual outcome between the three techniques at the 6 months follow up. Ten percentage of eyes had visual acuity less than 6/60. Although the lensectomy eyes required no secondary procedure than those had ECCE and scleral tunnel surgeries, the problem of aphakic spectacles in lensectomy eyes is a greatest barrier as well as cosmetically it is unappealing

Table 3 – Complications

Complications Lensectomy ECCE Scleral Tunnel
Iris Trauma 2 0 0
Lens fragments in vitreous 2 0 0
Cortical remnants 2 3 1
After cataract 0 4 2
IOL Decentration 0 2 0
Iris capture 0 1 1
Retinal detachment 1 0 1

In lensectomy and ECCE group, there was significant failure to remove all of the lens cortex, seen in 2cases and 3cases respectively. Iris trauma and loss of lens matter into the vitreous seen in 2 cases in both the groups. One should keep another machine stand by for machine failure in lensectomy, that was experienced in 2 cases. One lensectomy eye developed retinal detachment where as another case of tunnel surgery had preexisting retinal detachment. In one eye each,pupillary capture of lens developed in both ECCE and scleral tunnel group.IOL decentered in 2 eyes in ECCE group. After cataract noticed in 4 eyes of ECCE and 2 eyes of tunnel group,out of which one eye in each group was reoperated, surgical capsulotomy was done for dense after cataract. Aphakia in lensectomy group was routinely corrected with spectacles,bifocal spectacles were being used by 5 children.

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