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Outcomes of three piece PMMA intraocular lens implantations in traumatic pediatric cataracts in an eastern Indian cohort
Session Title: Paediatric Cataract Surgery
Session Date/Time: Monday 07/10/2013 | 16:30-18:00
Paper Time: 17:30
Venue: Forum (Ground Floor)
First Author: : A.Ganguly INDIA
Co Author(s): : J. Sengupta
To study the functional and visual outcomes of 3 piece PMMA lens implantation in traumatic pediatric cataract surgery performed at a tertiary care referral institute in an eastern Indian cohort.
Priyamvada Birla Aravind Eye Hospital. Kolkata. India. A tertiary referral care centre in eastern India.
Between January 2010 to January 2011, 24 eyes of 24 sequential pediatric patients with traumatic cataracts underwent cataract aspiration with primary posterior capsulorrhexis and anterior vitrectomy with PMMA 3 piece PCIOL implantation under GA. The IOL power was adjusted for age according to the AAO guidelines. The visual acuity at presentation and before surgery were noted. Associated injuries were noted. Thorough examination of anterior segment on the slit lamp and posterior segment evaluation were done by retina specialist. Patients with associated retinal detachments or corneal injuries involving visual axis were excluded. Primary repair of globe injuries if required were done.
Post operatively the children were followed up for complications, post operative uveitis , optic capture of IOL, secondary glaucoma, refractive errors, PCO formation , requirement of secondary procedures , visual acuity improvement ,amblyopia (which if present was treated rigorously with patching and followed up). Patients with at least 1 year of follow up post op were only included in this retrospective analysis.
The ages of the children were between 2.5 to 12 years with average age 8 years (median 8.5). There were 18 males and 6 females. Presenting visual acuities ranged between finger counting close to face to 618 (logMAR between 0.5 to 1.9, mean 1.37+/-SD 0.53 ). The interval between the injury and presentation varied between 24 hrs to 1.5 yrs. Out of 24 patients 2 had blunt trauma and the rest had penetrating injuries. Average implanted lens power was +21.45Dsph (range+18.5 to +24.5). Vision at first post op day ranged between-66p (0.0) to 160 (1.9).
Follow up was on 1st week 2nd week, 4th week and then monthly till 6 monthly and then 3 monthly till 1 year.
Visual acuity at final follow up ranged between 66 p (log MAR 0.0) to 624p (0.6) (mean 0.258, SD 0.2339). None of the patients had opacification of visual axis. There were no cases of IOL decentration. There were 3 cases of optic capture but without any visual significance. 7 patients had pigment deposits on the IOL. The residual refractive errors were ranged between -0.75Dsph to +4.0 Dsph (Mean 0.666. +/- SD 1.6).
All the surgeons were trained in pediatric cataract surgery and management of posterior capsule with rhexis and vitrectomy was routinely performed in all cases. The results of three piece PMMA IOL implantation in traumatic cataracts in children produce good visual and functional outcomes in trained hand with proper posterior capsule handling as per our study.