Management of anterior segment penetrating injuries with traumatic cataract by Pentagon approach in paediatric age group: constraints and outcome.

ABSTRACT

PURPOSE: To evaluate the efficacy of multiple combined procedure (Pentagon approach) as single-step secondary repair in cases of extensive keratolenticular trauma in paediatric age group. METHODS: Retrospective evaluation of 18 patients of penetrating injuries with sclerokeratolenticular trauma, who underwent multiple procedure as single-step secondary repair by a single team of two surgeons during a 4 year period. Surgical procedure included reconstruction of anterior segment, synechiolysis, excision of membrane, lensectomy, open sky vitrectomy, PC IOL implantation over frill and penetrating keratoplasty. Meticulous antiamblyopia measures were applied in all cases. RESULTS: Extensive vasoproliferative membrane, complicated cataract and anterior vitreous condensation were significant intra-operative hurdles. Moderate uveitis, secondary glaucoma, persistent epithelial defects were problems noted. Eleven (61.22%) patients attained good visual outcome. Regrafting was required in remaining cases due to delayed graft failure. CONCLUSION: Despite being a highly complex technique, Pentagon approach provides effective management profile in terms of graft success and functional outcome, especially in keratolenticular trauma, in children.