Scleral fixation posterior chamber IOL safe in children with traumatic cataract

J Pediatr Ophthalmol Strabismus. 2011;48(4):226-231.

Scleral fixation posterior chamber IOL implantation proved effective and reliable in children with traumatic cataracts who had inadequate posterior capsule support, a study found.

"Although the ... procedure is more difficult and has increased intraoperative complications compared with standard secondary IOL implantation in the sulcus or reformed capsular bag, it is believed to be acceptable considering the risks of other alternatives," the authors said.

The retrospective study included 24 eyes of 24 children. Average patient age was 5.8 years. All patients had corneal or corneoscleral lacerations that had been repaired 2 weeks to 3 months before IOL implantation.

A CZ70BD IOL (Alcon) was implanted via an internal route using triangular double scleral flaps. A 3-mm scleral tunnel incision was centered on the 12 o'clock position and widened to 7 mm to accommodate IOL insertion.

The scleral tunnel was affixed with 10-0 monofilament nylon sutures. Buried 8-0 polyglactin sutures were used to close the conjunctiva. Mean postoperative follow-up was 14.6 months.

Study results showed that visual acuity improved at final follow-up in 23 patients. Visual acuity was 20/200 or better in 18 eyes.

Fibrinous reaction was identified in six eyes, transient IOP increase in four eyes, membrane formation requiring removal in one eye, transient intraocular hemorrhage as vitreous hemorrhage in one eye and retinal detachment in one eye.

Results showed no evidence of endophthalmitis, suture exposure, suture breakage, IOL tilt, hypotony, iris capture of the IOL optic or choroidal effusion.

Further study with a larger patient sample and longer follow-up is warranted, the authors said.