CATARACT-SURGERY AND INTRAOCULAR-LENS IMPLANTATION IN CHILDREN

PURPOSE: To evaluate visual outcome and complications after extracapsu lar cataract extraction with posterior chamber intraocular lens implan tation in children. METHODS: Extracapsular cataract extraction with po sterior chamber intraocular lens implantation was performed on 20 eyes of 19 patients with traumatic cataract, ten eyes with unilateral cong enital or developmental cataract, and 15 eyes (eight patients) with bi lateral developmental cataract. Nd:YAG posterior capsulotomy was perfo rmed in the early postoperative period as indicated. RESULTS: Fourteen (70%) of 20 eyes with traumatic cataract had best corrected pseudopha kic visual acuity of 20/40 or better. When we excluded four eyes with macular injuries from analysis, 14 (87%) of 16 eyes had visual acuity of 20/40 or better. In patients with bilateral cataract in whom vision was quantified by Snellen acuity (nine eyes of five patients), nine o f nine eyes had best corrected pseudophakic visual acuity of 20/40 or better, In the remaining three patients, six of six eyes had central s teady and maintained fixation. Visual outcome was poorest in patients with unilateral cataract (ten eyes); one eye had best corrected pseudo phakic visual acuity of 20/40; two eyes, 20/60; two eyes, 20/70; one e ye, 20/100; and two eyes, 20/200. One additional eye had central stead y maintained fixation and noncentral fixation. Five of ten eyes had fo ur or more lines improvement in visual acuity, Postoperative complicat ions occurred in five eyes, each of which had traumatic cataract. Thre e eyes developed iris capture, one eye had a postoperative intraocular hemorrhage, and another developed a dense secondary membrane. In 45 p ostoperative eyes, 27 (60%) received one Nd:YAG laser posterior capsul otomy. A second Nd:YAG laser posterior capsulotomy was performed in 11 (41%) of these 27 eyes, CONCLUSIONS: Extracapsular cataract extractio n with posterior chamber intraocular lens im plantation in children ca n be accomplished in selected patients, with generally favorable resul ts. However, many of the patients in this series remain potentially am blyogenic, and long term follow up may temper our present visual resul ts.