|Year : 1983 | Volume
| Issue : 3 | Page : 294-297
The role of intraocular lens in traumatic cataract
Daljit Singh, Kamaldeep Singh, Jatinder Singh, Rajiv Sood
Department of Ophthalmology, Medical College, Amritsar, India
Department of Ophthalmology, Medical College, Amritsar
|How to cite this article:|
Singh D, Singh K, Singh J, Sood R. The role of intraocular lens in traumatic cataract. Indian J Ophthalmol 1983;31:294-7
|How to cite this URL:|
Singh D, Singh K, Singh J, Sood R. The role of intraocular lens in traumatic cataract. Indian J Ophthalmol [serial online] 1983 [cited 2013 May 22];31:294-7. Available from: http://www.ijo.in/text.asp?1983/31/3/294/29816
The treatment of traumatic cataract is part and parcel of the overall treatment of the injured eye. In the event of successful surgery of cataract, and the correction of other consequences of injury, the problem is reduced to the rehabilitation of a unilateral aphake. Aphakic glasses may not be useful, since they cause diplopia. Further a patient wearing aphakic glasses has a very blurred peripheral vision.
The cases of aphakia resulting from surgery on the injured eye can be better rehabilitated either with contact lenses or with intraocular lenses,.
The present study deals with our limited experience of the use of intraocular lenses in cases of traumatic cataract.
| Materials and Methods|| |
A total of 61 cases have been treated. [Table - 1] shows the age and sex distribution.
There is a preponderance of patients in the younger age-groups. Further the number of female patients is much smaller than the males.
The types of injuries leading to cataract formation were as shown in [Table - 2].
The associated ocular damage seen in the patients was as shown in [Table - 3].
The duration between the injury and the time of examination varied between I day to 15 years. The average was 1 year and 10 months.
The surgical management was tailored to the needs of each patient, to correct associated ocular damage. 29 patients (47.5 %) had only cataract surgery at first stage, they later received secondary lens implants. Primary implantation was done in 32 patients (52.5 %). Effort was made to minimize trauma to the endothelium while doing intraocular manipulations. The incision was closed with many interrupted stainless steel sutures.
Types of I.O.L.s. used
Shah's iris clip lenses were used in 6 cases (9.8 %), Copeland lens in 1 case (1.6 %) and Singh-Worst irisclaw lenses in 54 patients (88.6 °o). [Figure - 1] shows pre and post-operative appearances of a patient with traumatic cataract caused by penetrating injury with a toy-arrow. [Figure - 2] illustrates the patient who suffered penetrating injury with iris prolapse caused by a sharp finger nail. The iris was excised and the wound sutured with steel sutures.
Secondary lens implantation was done at a later date. [Figure - 3] shows primary implantation in a case of electric cataract.
Vitreous had to be cut in 5 cases (8.2 %). The lens matter could not be satisfactorily removed in 2 cases (3.3 %). Small quantity of blood was present in the anterior chamber at the end surgery in 3 cases (4.9 %).
Immediate Postoperative Complications
[Table - 4] shows immediate postoperative complications.
20 patients (32.8 %) developed after-cataract and needling was done. One patient (1.6 %) developed endothelial corneal dystrophy and her vision deteriorated from 6/9 to 1/60. It was caused by the implant touching at one point to the back of the cornea.
The patients have been followed from 2 months to 50 months, with an average of 7.6 months.
[Table - 5] shows the final visual results.
In 5 patients the vision could not be recorded due to very young age and consequent lack of cooperation from them. However they all appeared to have fair amount of sight as judged by the parents.
| Discussion|| |
Successful rehabilitation of cases of traumatic cataract depends upon the type, the extent of injury, the first aid received, the time and quality of specialist's attention and the choice of rehabilitative procedures adopted.
The success rate with cataract lenses or intraocular lenses depends upon the choice of the patients, the surgical technique employed, the operative and postoperative complications encountered etc. In lens implant cases the success will further depend upon the experience of the surgeon and the choice of intraocular lens design. A high rate of success has been reported by various authors,,
In our series 60.4 % patients had corrected visual acuity better than 6/12 and 83.3 % of the patients had acuity better than 6/24. Considering the patients where visual acuity could be recorded, the average visual acuity was 0.58, i.e. better than 6/12.
Singh-Worst iris claw lens implant has been found to be a useful choice for treating cases of traumatic cataract. The utility and versatility of this implant has been proved under extremely difficult and demanding conditions of ocular trauma. This lens can be used as a primary or a secondary procedure with equal facility. The presence or absence of the posterior capsule is immaterial for its implantation. The technique of implantation has been described earlier.
Intraocular lens implantation is made easier by extracapsular cataract extraction. An intact capsule is extremely useful for secondary lens implantation. It is thus felt that when dealing with cases of traumatic cataract, every attempt should be made to preserve the posterior capsule so that an intraocular lens implantation, if desired at a later date could be done more safely. Irrigation aspiration should be used to remove the cortical matter. Only lactated ringer or balanced salt solution should be used for irrigation. The normal saline solution can prove disastrous for the cornea. Since many cases will need steroids in the postoperative period, it is necessary to have a near fool-proof closure of the incision line. In our experience stainless steel suture has given satisfactory results.
| Summary|| |
61 cases of traumatic cataract have been treated with intraocular lens implants. The majority (88.5 %) of the implanted lenses are Singh-Worst iris claw lenses. The average visual acuity achieved was 0.58.
| Aknowledgements|| |
Our profound thanks to Dr. Jan Worst (Holland) for providing mature ideas and many materials which formed the backbone of the study.
| References|| |
|1.||Jain, I.S., Bansal, S.L., Dhir S.P., Kaul, R.L., Gangwar D.N., 1979. Journal of Paediatric Ophthalmology & Strabismus 16, (5): 301-305. |
|2.||Hiles, D.A., Jot. Ophthal. Clin. 17, (4): 222, 1977. |
|3.||Egodorov, S.N., Egorova, E.V., Zubareva, L.N., Am. Intra--Ocular Implant Soc. J., 7 (2): 144, 1981. |
|4.||Singh D., Worst J.G.E., Proceedings of All India Ophthalmological Conference, Udaipur under publication, 1981. |
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]