Corrección de la afaquia postraumática en niños con lentes plegables suturadas al iris / Correction of Posttraumatic Aphakia in Children with Folding Lenses Sutured to the Iris

Objetivo: Caracterizar resultados visuales del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos. Métodos: Se realizó un estudio preexperimental, prospectivo, longitudinal con 17 niños, con seguimiento de un año. Se les realizó examen oftalmológico completo y se evaluaron variables como edad, sexo, lateralidad, mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, y complicaciones. Resultados: La edad promedio fue de 13,2 años, masculinos fueron el 64,7 por ciento. La mejor agudeza visual sin corrección en el preoperatorio fue del 47,1 por ciento <0,1 y con corrección de 0,7, al año del posoperatorio fue de 0,43/0,78, respectivamente. La presión intraocular preoperatoria fue de 14,1 mm Hg, y al año 14,71 mm Hg. La densidad celular en el preoperatorio fue de 2559.76 células/mm2 y al año de 2475,88 células/mm2. La hexagonalidad preoperatorio fue del 53,12 por ciento y al año del 56,94 por ciento. El cilindro preoperatorio -1,35 D y el 23,5 por ciento presentó astigmatismo inducido al año del posoperatorio. Conclusiones: La aplicación del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos logra mejorar su agudeza visual y la complicación más frecuente fue el edema corneal(AU)

Objective: To characterize visual outcomes of iris-sutured posterior chamber foldable intraocular lens implantation in traumatic aphakia in pediatric patients. Methods: A pre-experimental, prospective, longitudinal, pre-experimental study was performed with 17 children, with a one-year follow-up. A complete ophthalmologic examination was performed and variables such as age, sex, laterality, best visual acuity without correction, with correction, refractive results, intraocular pressure and complications were evaluated. Results: The average age was 13.2 years, 64.7 percent were male. The best visual acuity without correction preoperatively was 47.1 percent <0.1 and with correction 0.7, one year postoperative visual acuity was 0.43/0.78, respectively. Preoperative intraocular pressure was 14.1 mm Hg, and at one year 14.71 mm Hg. Cell density preoperatively was 2559.76 cells/mm2 and at one year 2475.88 cells/mm2. The preoperative hexagonality was 53.12 percent and at one year 56.94 percent. Preoperative cylinder -1.35 D and 23.5 percent presented induced astigmatism at one year postoperatively. Conclusions: The application of posterior chamber foldable intraocular lens implant sutured to the iris in traumatic aphakia in pediatric patients achieves improved visual acuity and the most frequent complication was corneal edema(AU)

A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses.

Background: A new emerging complication of trans‑scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans‑scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow‑up. Conclusions: Steel suture is a viable option for trans‑scleral fixation of posterior chamber intraocular lens.

Long Term Follow-Up of Epikeratophakia in the Pediatric Aphakia

We performed 3 cases of epikeratoplasties on two pediatric aphakic patients who were intolerable to contact lenses & spectacles. These epikeratoplasties were performed in accordance with the Kaufman-McDonald Epikeratophakia Method using the commercially available frozen and dried Kerato-Lens (Allergan Medical Optics), the lenticule of which was rehydrated at the time of surgery. The cataract extractions were performed at 3 months after birth on both eyes of the congenital cataract & at 18 months after birth on the traumatic cataract that had developed at 14 months after birth. The epikeratoplasties for the eyes with congenital cataract were performed at 24 months on the right eye and at 16 months after birth on the left eye respectively. The epikeratoplasty for the traumatic cataract eye was performed at 28 months after birth. The 3 grafts have remained successful over the follow-up period of 4 to 6 years. The right eye of congenital cataract case had myopic shift of 3.75D and best corrected visual acuity of 0.2 during 5-year of follow-up period and the other left eye had myopic shift of 4.75 D and best corrected visual acuity of 0.7 during 6-year of follow-up period. The traumatic cataract case had myopic shift of 1.0 D and best corrected visual acuity of 0.05 during 4-year of follow up period. In view of this, it is considered that the epikeratoplasty is of an effective treatment in correcting the refractive error in the pediatirc aphakia patients who intolerable to contact lens and in whom difficulty exists in determining whether an intraocular lens implantation is appropriate or not.