Pediatric lens implantation

Abstract

Regarding the recent article by Lesueur and Arne,1 I think I can probably claim to have been the first to attempt the correction of unilateral high myopia in children. I used modified Strampelli noncompressible tripod anterior chamber lenses placed in front of the iris and behind the cornea. Chapter 20 of my book2 contains the following statements: “There are 6 cases in this series [of uniocular high myopia], 4 children and 2 adults. The children's ages were five, five, eight, and twelve when the implants were inserted. The anisometropia varied between 10 and 15 D. The other eyes were emmetropic. They were discovered to have defective vision in one eye at routine school medical examination; in 3 this was associated with a manifest convergent squint. After implant insertion, the good eye was occluded for three to six months. The visual results 2 years later were: 3/60, 6/60, 6/36 and 6/36. The 3/60 case had eccentric fixation, and the other 3 appeared to have macular fixation but with a fairly dense amblyopia. Pleoptic stimulation has not been tried in these cases.” “Thus, the insertion of implants with a concave optic portion to correct high myopia appears to be technically straightforward and as yet unaccompanied by serious complications. Cases of uniocular high myopia are unlikely to benefit greatly unless treated at an early age. I think it is scarcely worth inserting an implant if a manifest squint is present and the uniocular high myopia is complicated by dense amblyopia. “In older patients the insertion of an implant may benefit an occasional case of uniocular high myopia if the corrected vision is 6/18 or better, and if the spectacle correction cannot be worn without experiencing asthenopia or diplopia. “On the other hand, the treatment of binocular high myopia with bilateral implants may be brilliantly successful, and may completely transform the psychological and educational prospects of a young person, or give a busy adult a few more years of gainful employment before he or she is finally overtaken by the tragic end-results of progressive degenerative myopia.” Indeed, the whole of this chapter could usefully be read by any refractive surgeon concerned with the treatment of high myopia. Perhaps I might conclude by mentioning that although this book has been out of print for 30 years, modern photocopying techniques have improved so greatly that excellent copies can be obtained from Rayner Intraocular Lenses Ltd, Sackville Road Trading Estate, Hove, East Sussex BN3 7AN, United Kingdom (telephone: 01273 205401). This book was the first publication to be devoted exclusively to lens implantation, and I did my best to ensure that it embodied everything that was known about the subject at that time. Peter D. Choyce BSc, MS, FRCS, FRCOphth aWestcliff-on-Seg, United Kingdom