PRIMARY INTRAOCULAR-LENS IMPLANTATION FOR PENETRATING LENS TRAUMA IN AFRICA

Objective: This study aimed to audit the surgical strategy of primary posterior chamber intraocular lens implantation for cases of recent pe netrating trauma involving the lens in an African population. Design: Retrospective, noncomparative case series. Participants: Seventy-two c ases are reported, including all patients who underwent primary intrao cular lens implantation for traumatic cataract extraction performed wi thin 1 month of injury between 1988 and 1996. Main Outcome Measures: D emographic characteristics and follow-up attendance rates ave analyzed . Surgical technique and the occurrence of intraoperative and postoper ative complications are reported. Visual outcomes are reported with de tailed analysis for cases of poor visual outcome. Results: Mean age wa s 14.3 years (standard deviation = 11.1), 57 (79%) were male and 15 (2 1%) wove female (chi-square = 23.66, P < 0.01). Fifty-eight patients ( 80%) attended for follow-up with a mean follow-up duration of 14.3 mon ths (standard deviation = 17.3). No demographic or surgical difference s were identified between attendees and nonattendees. The posterior ca psule had been breached by the trauma in 27 (38%) cases, and 15 of the se required anterior vitrectomy. Capsular fixation of the implant was achieved in 49% of patients, the remainder having sulcus fixation. Int raoperative rupture of the posterior capsule occurred in four cases. T he only common postoperative complication was acute fibrinous anterior uveitis, which occurred in 29 (40%) patients, and 32% of patients fol lowed up for at least 6 months required secondary posterior capsulotom y. This was more common in younger patients (chi-square = 4.2, P < 0.0 5). Corrected postoperative visual acuities were available for 51 pati ents, of which 71% achieved 20/60 or better visual acuity. Patients 6 years of age or younger were less likely to achieve 20/60 (chi-square = 6.61, P = 0.01). Conclusions: This surgical strategy has proved succ essful, producing good visual results and causing no sight-threatening complications. Primary posterior capsulotomy may be appropriate for y ounger patients.