|Year : 1984 | Volume
| Issue : 6 | Page : 499-500
Intraocular lenses in children
Deptt. of Ophthalmology, Med. College, Amritsar, India
Deptt. of Ophthalmology, Med. College, Amritsar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh D. Intraocular lenses in children. Indian J Ophthalmol 1984;32:499-500
The use of intra-ocular lenses in children probably will remain controversial for years to come. There are a number of reasons including deprivation amblyopia, surgical difficulties and unpredictability of the final results of lens implantation.
Going through the literature one finds that probably far less than 1,000 intraocular lens implantations have been done in the children thus far.
The article briefly describes our experience in a series of 129 cases operated during the last 42 years. The age distribution was as follows :
| Material and methods|| |
Out of 129 cases there were 103 males and 26 females.
The surgery was performed under general anaesthesia in all the cases below 10 years of age. Most of the patients above the age of 10 were very co-operative and were given local anaesthesia. Hypotony was achieved by prolonged ocular pressure at 30 mHgm or by strong ocular massage for a few minutes. The lens for implantation in every case was a Singh-Worst Iris Claw lens .
In the early cases a single incision of 160° was made. In these cases the upward thrust of the vitreous was seen. Thereafter the incision was made at two places-a 30° incision at the upper inner limbus and a 60° + incision at the upper outer limbus.
Before implantation of the lens the cataractous lens was removed after the usual capsulotomy and irrigation/aspiration. In traumatic cases, the iris adhesions to the lens and to the cornea were cut. A large number of traumatic cases had varying amounts of deformities in the anterior segment which were corrected to the best of our ability.
Singh-Worst lens is introduced from the temporal side under air or fluid. The claw on the nasal side is applied to the iris as soon as the lens is taken to desired central position. The act of enclavation of the iris is done by a Pierce Hoskins forceps introduced from the nasal incision while the lens is steadied by the forceps from the temporal incision. The temporal iris claw is fixed as usual.
| Observations|| |
5 patients had rupture of the posterior capsule with consequent vitreous disturbance. Another 5 patients belonging to traumatic group already had vitreous in the anterior chamber. In 8 cases vitrectomy was done by sucking with syringe and cutting. In the last 2 cases satisfactory vitrectomy was done by a vitrector.
Immediate post-operative problems
In the early few cases the chamber was found to be shallow in very young patients This was traced to excessive lens matter left behind the iris and probably to leakage caused by poor suturing coupled with crying of the children. This problem was successfully tackled in-most of the latter cases. Corneal haze and striate keratitis was common in the early cases where implantation was done after a single large incision. The incidence became negligible when implantation was made after two incisions described above. In addition, we started using methyl cellulose on the lens prior to introduction in difficult cases. This also prevents trauma to the endothelium.
Additional surgery like peripheral iridectomy, freeing of the iris from the angle and needling for after cataract was required in 25 cases (19.38%).
3 patients had severe trauma to the eye in late post-operative period. They had a partial or complete dislocation of intraocular lens alongwith a host of other problems which necessitated removal of intra-ocular lens.
The patients have been followed from 2 months to 42 years with an average of 2 years and 1 month.
It has not been possible to examine the vision of each and every patient due to obvious reasons. The number of patients where vision could be recorded is 97. The detail of visual results is as follows
We have not undertaken so far the study of binocular vision functions in our patients.
| Discussion|| |
Cataract or Aphakia in children in our country is a matter of grave concern for the parents and the surgeons The whole development of vision as well as the personality of the child depends upon giving best possible visual acuity to the young patients at the earliest possible. It places heavy responsibility on the surgeon who is using a modality like intra-ocular lens which does not have a very strong professional support in this country, especially because the very long term results are unknown. The choice of the type of implant is even more difficult. We chose Singh-Worst Iris Claw lens for a number of reasons-it is a very small and very light weight lens. It is fixed to the midperiphery of the iris and it completely avoids the angle and the pupil. It is easy to do needling in case of after cataract. The lens can always be watched for any problem. The lens can be easily removed if subsequent events necessitate this action.
It is our belief that intra-ocular lens is an important weapon to save visual function and binocularity in young patients with cataract.
| References|| |
Singh, D., 1982, Ind. J. Ophthalmol. 30: 457.
[Table - 1], [Table - 2]