Lens Aspiration Research Articles

Cataract as the First Manifestation of Insulin Dependent Diabetes Mellitus

An 8-year-old girl presented with blurry vision. Examination revealed impaired visual acuity (VA) in both eyes and significant lamellar and posterior subcapsular cataracts requiring surgery. Preoperative laboratory tests indicated elevated urine and blood glucose levels, leading to a diagnosis of insulin-dependent diabetes mellitus by a paediatric endocrinologist. She began insulin treatment and underwent lens aspiration with posterior chamber intraocular lens implantation. Postoperatively, her VA improved to 20/30 in the right eye and 20/60 in the left eye.

Development and Comprehensive Assessment of the Clinical Effectiveness of a Method For Cataract Phacoemulsification Based on a Single Tunnel Incision

Purpose. Development and evaluation of the clinical effectiveness of a technique for performing phacoemulsification of cataracts (FEC) based on a single tunnel incision.Patients and methods. We observed 96 patients (96 eyes, age 58.2 ± 1.2 years, 61 men, 35 women), divided into two groups equal in age, gender and visual status: control (CG, 46 patients, 46 eyes), for whom FEC was performed using the traditional method (total incision length 4.6 mm) and the main group (MG, 50 patients, 50 eyes), for whom FEC was performed using the developed method (total incision length 2.2 mm). The basis of the developed technique is to make a tunnel incision 2.2 mm long on the temporal side, followed by capsulorhexis, phacofragmentation, phacoemulsification of the lens nucleus and aspiration of the lens masses through a single tunnel incision. In this case, during phacofragmentation, a longitudinal fracture of the lens nucleus is performed along the axis 0–180°, the lens nucleus is rotated along the meridian 90–270° and another longitudinal fracture of the lens nucleus is performed along the axis 0–180°, and after phacoemulsification of the nucleus, aspiration is performed through a coaxial handle and IOL is implanted. A comparative assessment of the clinical effectiveness of the developed and traditional methods was carried out using clinical, refractive, morphological and biochemical parameters.Results. A higher clinical effectiveness of FEC using the developed method has been established (compared to the traditional one), which is confirmed by a decrease in the magnitude of surgically induced astigmatism (by 0.13 diopters, p < 0.001) and a tendency towards higher postoperative uncorrected distance visual acuity (by 0.05 rel. units, p > 0.05). Along with this, in the МG, compared with the CG, a pronounced decrease in the incidence of dry eye syndrome (by 3.4 %, p < 0.05), C­reactive protein in the tear fluid (by 1.1 mg/l, p < 0.05) and preservation of the number of endothelial cells (by 4.8 %, p < 0.01).Conclusion. The developed technique for performing FEC is an effective prevention of surgically induced astigmatism and negative effects on the corneal endothelium and ocular surface, which is associated with a decrease in the total length of the incision (2.2 mm compared to 4.6 mm) and an intraoperative decrease in the total volume of circulating fluid.

Intraoperative challenges and outcomes of pediatric cataract surgery following glaucoma filtering surgery.

To analyze the intraoperative challenges of cataract surgery in children, following glaucoma filtering surgery. This was a retrospective study to analyze intra-op challenges and outcomes of pediatric cataract surgery in post-glaucoma filtration surgery eyes, between January 2007 and December 2019. We included 20 eyes of 16 children. The most common glaucoma surgery performed was trabeculectomy and trabeculotomy (14 eyes). The median age at the time of cataract surgery was 74.5months. The most common cataract surgery performed was lens aspiration with posterior chamber intraocular lens implantation (LA + PCIOL) (9/20). The most common intraoperative challenge faced was difficulty in capsulorrhexis (ten eyes), followed by extension of primary posterior capsulotomy (six eyes). At the final follow up eight eyes had improvement in visual acuity, five eyes had stable visual acuity and five eyes had a drop in visual acuity. In 12/20 eyes IOL was implanted, nine eyes in-the-bag and three eyes had in ciliary sulcus. None of the IOLs in the bag had decentration of IOL. The median postoperative IOP (p = 0.12) and median number of postoperative AGM (p = 0.13) at 2years remained stable compared to the preoperative values. The IOP remained well controlled in 4 eyes without anti-glaucoma medications and in 14 eyes with anti-glaucoma medications and none needed additional surgery for IOP control. Two eyes developed retinal detachment postoperatively. Cataract surgery in pediatric eyes with prior glaucoma surgeries, have challenges with capsulorrhexis and IOL stability. The visual outcomes were reasonably good so was the IOP control.

Anterior Segment Dysgenesis in A Child, A Rare Case Report: What Should We Do?

Introduction : Anterior segment dysgenesis affects a various range of ocular structure, including: cornea, iris, ciliary body, anterior chamber, and lens associated with approximate 50% of glaucoma
 Case Illustration : A 20 month-old boy presented with bilateral corneal opacity. VA was 6/480 on both eye. Examination revealed bilateral central corneal opacity with keratolenticular adhesions, anterior lens dislocation and opacification, aniridia, and posterior segment were difficult to evaluate. The IOP were 17.3 mmHg and 14.6 mmHg in the right and left eye respectively. The aforementioned feature contributed to the diagnosis of Type II Peters Anomaly (PA). Lens aspiration combined with adhesiolysis on the LE was performed. Patient was given topical antibiotic, corticosteroid, and anti- glaucoma medication post-operatively. Postoperative course showed no complication and the corneal opacity diminished
 Discussion : Lens aspiration in combination with adhesiolysis was performed because the presence of cataract interfered the visual axis and increased the risk of corneal decompensation due to keratolenticular adhesions. We considered to perform the surgery on the LE first because the corneal opacity was milder than the RE. Glaucoma is an almost ineluctable issue and medical therapy are necessary. Further evaluation was required to determine if a similar procedure is needed for the fellow eye and whether the IOL implantation was going to enhance the visual prognosis in the future
 Conclusion : The keratolenticular adhesions and corneal opacity in type II PA make the surgical approach more challenging. Cautious manipulation can prevent further corneal decompensation. In addition, parents should receive extensive counseling regarding the complications and prognosis

Case series of spontaneous bilateral absorbed cataracts running in a family

There are only a handful of case reports and studies available regarding spontaneously absorbed cataracts and their management, including the surgical techniques and results following the management. In our study, on retrospective analysis, after a thorough search of the concerned literature, we encountered a series of cases of bilateral spontaneous absorbed cataracts running in a family with no such documentation. This retrospective study included 11 patients (aged between 3 and 65 years and of either sex) of the same family having bilateral absorbed cataracts. All patients underwent best-corrected visual acuity (BCVA); a thorough eye examination; rubella titer estimation; intraocular lens (IOL) power calculation; lens aspiration with or without posterior capsulotomy, anterior vitrectomy (AV), or IOL implantation; and visual rehabilitation. All patients had bilateral absorbed cataracts, which were acquired in an autosomal dominant pattern. Preoperative BCVA distance: 22 eyes had either counting fingers close to the face or counting fingers at 1–2 feet. The presence of high-frequency mixed bilateral nystagmus was noted in four patients. Anterior continuous curvilinear capsulorhexis was possible. Cortical aspiration was uneventful. In the capsular bag, implantation was possible in the majority of cases. No postoperative inflammation was noted, and the IOL was well-centered in all patients. To the best of our knowledge, this is the first study to report a case series of bilateral absorbed cataracts running in an Indian family with no syndromic association, no history of mental retardation, or infection. Anatomic disorganization of the absorbed lens makes surgery in such cases challenging. By using appropriate surgical methods and good visual rehabilitation, satisfactory surgical and visual outcomes can be achieved.

Congenital Bilateral Aniridia with Ectopia Lentis: A Case Report

Aniridia is characterised by variable degrees of hypoplastic iris or complete absence of iris tissue and is a rare congenital disorder. Mutation in the PAX6 gene is mostly responsible for aniridia. It is associated with various ocular manifestations involving both anterior and posterior segments of the eye. A 14-year-old male patient, presented to the ophthalmology outpatient department with complaints of a gradual decrease in vision in his left eye. Upon examination, photophobia and bilateral aniridia associated with nystagmus were present in both eyes, along with a sclerally fixated intraocular lens in the right eye and a superiorly subluxated mature cataract in the left eye. Intraocular pressure was elevated in the left eye. Gonioscopy revealed rudimentary iris tissue in both eyes. Upon systemic examination, the patient was diagnosed with hydro-ureteronephrosis of the right-side, which was asymptomatic, and borderline intellectual functioning. This case highlights the unique features of WAGR syndrome (Wilm’s tumour, Aniridia, Genito-urinary anomalies, Range of developmental delay) presenting with aniridia and genito-urinary conditions, along with borderline intellectual functioning without the presentation of Wilm’s tumour. Cataract extraction by lens aspiration with scleral fixation of intraocular lens implantation was performed in the left eye. This study adds to the broader knowledge of the disease entity’s spectrum, exploring the diagnostic challenges associated with the case and potentially influencing diagnostic criteria. It may guide future studies exploring the diverse clinical presentations of WAGR syndrome.

Implantable Collamer Lens in Management of Unilateral High Myopia After Pseudophakia for Traumatic Cataract: Piggybacking With Two Lenses in the Sulcus

Purpose: To describe the management of unilateral high myopia after pseudophakia for traumatic cataract by piggybacking an Implantable Collamer Lens (ICL) (V4C ICL; STAAR Surgical) along with a primary intraocular lens (IOL) in the sulcus. Methods: A 24-year-old woman underwent lens aspiration with non-foldable IOL implantation in the sulcus at 5 years of age for post-traumatic cataract. She had regular follow-up for 21 years and developed unilateral high myopia. She was using contact lenses and wanted laser vision correction. An Implantable Collamer Lens in the sulcus was used to manage the unilateral high myopia in this pseudophakic patient with a rigid IOL in the sulcus. Results: Her corneal thickness was less than 500 µm. Except for raised intraocular pressure in the immediate postoperative period, she had uneventful postoperative recovery. Her uncorrected distance visual acuity (UDVA) at 4 weeks improved to 6/9. The patient was followed up for 7 months and had a UDVA of 6/9, intraocular pressure on Goldmann applanation tonometry of 14 mm Hg, adequate vault height (1.057 mm), good anterior chamber depth (1.739 mm), and no deposits on either of the lenses. Conclusions: An ICL can be used over a primary IOL in the sulcus for the correction of ametropia, although additional cases need to be evaluated for the proper sizing and results in similar patients. [ Journal of Refractive Surgery Case Reports. 2023;3(4):e42–e46.]

Bilateral dense coin-like lenticular opacities in an infant

A 6-month-old child with impaired vision was taken to a tertiary care hospital. Ocular examination revealed no abnormalities, but under anesthesia, ultrasonic biomicroscopy (UBM) found small, white, and dense lenticular opacities, which were further confirmed on the intraoperative clinical examination. The morphology of these coin-like opacities was distinct from previously described pediatric cataracts, being larger than those in cataract pulverulenta and thinner than “ant-eggs.” The child underwent lens aspiration, anterior vitrectomy, and intraocular lens (IOL) insertion. Understanding the unique morphology of this cataract may contribute to improved management of similar cases and deepen our knowledge of lens embryology and etiopathogenesis of cataract.

Lens-Sparing Surgery for Retrolental Stalk in Persistent Fetal Vasculature

To describe a new surgical technique and outcomes of lens-sparing vitrectomy and retrolental stalk dissection in posterior persistent fetal vasculature (PFV). Retrospective interventional case series. RESULTS: Among the 21 included eyes, 8 (38%) had no macular involvement and 4 (19%) presented with microphthalmia. Median age at the first surgery was 8 months (range: 1-113 months). Surgical success was obtained in 71.4% of cases (15 of 21). In the remaining cases, the lens was removed because of capsular rupture in 2 cases (9.5%) and a large capsular opacity after stalk removal or an adherent stalk impossible to dissect in 4 cases (19.1%). In the capsular bag, IOL implantation was accomplished for all but 1 eye. None of the eyes developed retinal detachment or required glaucoma surgery. Endophthalmitis occurred in 1 eye. Secondary lens aspiration was needed in 3 eyes after a mean interval of 10.7 months following initial surgery. At last follow-up, half of the eyes remained phakic. Lens-sparing vitrectomy is a useful approach to addressing the retrolental stalk in selected cases of persistent fetal vasculature syndrome. By delaying or avoiding lens extraction, this approach allows preservation of accommodation, reduction of the risk of aphakia, glaucoma, and development of secondary lens reproliferation.

A Baby Girl Born with Bilateral Congenital Cataract to A Mother with Unilateral Congenital Cataract Treated in Childhood

We hereby disseminate a case of a baby girl, who at ten months of age received MMR vaccine but was discovered to later have unilateral congenital cataract at eight years of age. At 25 years, she was married giving birth to a baby boy who had normal vision. Unfortunately, the second baby girl was detected to have bilateral cataract for which the baby at four months of age underwent lens aspiration and anterior vitrectomy of both eyes at a gap of one week. A month later a glass with bilateral +21 Diopters were prescribed. She is planned for intraocular lens implant at around four years of age. She is on currently on visual rehabilitation and treatment for amblyopia Learning lesson from this case being the fact that congenital cataract may run in family and may impart vision deprivation in the offspring; therefore, the importance of preconception counseling is important.

Bilateral congenital cataract in a child with fetal valproate syndrome

Fetal valproate syndrome (FVS) results from valproate intake during pregnancy. Children with FVS may have various ocular abnormalities such as refractive error, amblyopia, and strabismus. Congenital pediatric cataract has been reported earlier in two cases. We describe a case of FVS, who presented to us with a bilateral total white cataract. The child underwent bilateral lens aspiration + posterior capsulorhexis + anterior vitrectomy + intraocular lens (IOL) implantation under general anesthesia followed by refraction.

Comparison of ultrasound phacoemulsification and FemtoMatrix® PhotoEmulsification® cataract surgery.

To introduce a novel technology currently under final development before regulatory approvals for the furtherment of cataract surgery, using the FemtoMatrix® laser system, and to demonstrate its safety and efficacy as compared to standard ultrasound phacoemulsification. Thirty-three patients with bilateral cataracts were operated on with one eye undergoing PhotoEmulsification® treatment on the FemtoMatrix® device and the contralateral eye receiving the control procedure, i.e., standard ultrasound phacoemulsification treatment. The number of "zero-phaco" procedures (denoting that I/A alone was sufficient to aspirate the lens fragments and that no ultrasound energy was needed) was recorded and Effective Phaco Time (EPT) values were compared. The patient follow-up was 3 months. Thirty-three eyes from a population with a mean cataract grade of 2.6 were treated on the FemtoMatrix®, of which 29 were "zero-phaco" (88%). All patients were operated on by a single surgeon who was a relative novice to the technology (63 patients treated prior to this study). Conversely, of the 33 fellow eyes who underwent standard ultrasound phacoemulsification, none were zero-phaco (0%) - all required varying degrees of ultrasound energy to make lens aspiration possible. The mean EPT was significantly lower in the PhotoEmulsification® laser group (0.2 ± 0.8 s) than in the phaco group (1.3 ± 1.2 s) (p < 0.0001). The safety profiles of the two procedures were comparable, with no device-related adverse events noted. FemtoMatrix® is a promising femtosecond laser platform that, when compared to phacoemulsification, significantly decreases or eliminates EPT altogether. The system is used to perform PhotoEmulsification®, making zero-phaco cataract procedures feasible including in high-grade cataracts (>3). It enables personalized treatment by automatically measuring and adapting the laser energy required to obtain the most efficient cutting of the crystalline lens. This new technology appears to be safe and effective in cataract surgery.

Kissing microvitreoretinal blade technique: A novel approach for safe and effective endocapsular lens aspiration in microspherophakia.

We herein describe the kissing MVR technique in cases of microspherophakia for safe and effective endocapsular lens aspiration. Microspherophakia is associated with abnormally lax and broken zonules, which pose a great challenge to the operating surgeon, especially while creating the openings in the capsular bag. In this novel technique, simultaneous use of two 23 G MVR blades reduces the above problem associated with the severely mobile lens. Here, one MVR blade stabilizes the capsular bag and, at the same time, provides counter-traction for the opposite MVR blade while puncturing the capsular bag. Furthermore, the creation of openings in the lens at the equator or just posterior to it is beneficial as the capsule is relatively thicker and stronger at this location. This also minimizes the risk of premature extension to the anterior or posterior capsule, thereby avoiding complications like dropped lens matter, vitreous prolapse, and vitreous traction.

Long-term Results of Congenital Cataract Surgery with Primary Intraocular Lens Implantation: A Case-Control Study of Three Age Groups.

To analyze the results of ocular refraction at the age of 7 years in children after congenital cataract surgery with intraocular lens (IOL) implantation. A study of ocular biometric data of 143 eyes who underwent lens aspiration with IOL implantation in unilateral (23 eyes) and bilateral (60 eyes) congenital cataracts was performed. All children were divided into groups according to the age categories at the time of surgery: Group A (0-12 months) - 43 eyes; Group B (12-36 months) - 45 eyes; and Group C (older than 36 months) - 55 eyes. An empirical reduction of the implanted IOL power was performed: an undercorrection of 20% in children aged 0 to 36 months and 10% less in children aged 36 to 60 months. By age 7 years, the mean elongation ± standard deviation (SD) in Group A was 3.93 ± 1.64 mm, 2.13 ± 0.94 mm in Group B, and 0.95 ± 0.76 mm in Group C (18.7%, 9.5%, and 4.1% of the baseline axial length, respectively). There was no significant difference in axial elongation between unilateral and bilateral congenital cataracts (P = 0.32). The mean absolute refraction error (MAE) at last examination was 3.99 ± 2.12 diopter (D), 2.46 ± 1.48 D, and 1.59 ± 1.31 D in Groups A, B, and C, respectively. In infants younger than 7 months of age, by age 7 years, the mean elongation ± SD was 3.27 ± 2.86 mm (25.5%) and MAE was 3.44 ± 2.1 D. The prevalence of preoperative corneal astigmatism of 1.0 D or more was 48.95%, 2.0 D or more was 27.27%, and 3.0 D or more was 5.6%. There was no significant difference in preoperative corneal astigmatism between unilateral (1.62 ± 0.77 D) and bilateral (1.78 ± 0.90 D) congenital cataracts (P = 0.56, 95% confidence interval = -0.50-0.28). Best-corrected visual acuity (BCVA) more than 20/40 was in 53.49%, 55.55%, and 74.54% in Groups A, B, and C, respectively. Although IOL power was calculated in accordance with children's age, at the age of 7 years, there was a different degree of ametropia because of the biometric changes of the growing eye, and a higher rate of ametropia was observed more in the younger age group than in the elder age groups.

Outcomes of surgical intervention in cases of ectopia lentis.

Purpose:To evaluate the outcomes of surgical intervention in cases of ectopia lentis.Methods: This retrospective study included all cases of ectopia lentis that presented between June 2015 and March 2019 in a tertiary care center. They were reviewed retrospectively. The corrected distance visual acuity (CDVA), severity of lens subluxation, type of surgery, intra-operative and post-operative complication, and specular count were recorded.Results: Seventy-eight eyes of 57 cases with a mean age at surgery of 14.73 years were analyzed. Intra-lenticular lens aspiration was the most common (n-62/78; 79.5%) surgical procedure followed by lens aspiration, intra-capsular cataract extraction, phaco-aspiration, and pars-plana lensectomy. Simultaneous intra-ocular lens (IOL) implantation was performed in 46.2% (n-32/78) of the eyes. The mean CDVA improved from 0.85 ± 0.55 logMAR to 0.44 ± 0.29 logMAR at 6 weeks follow-up. The post-operative CDVA was significantly better in the pseudo-phakic group compared to the aphakic group (p-0.02). The patient’s age at the time of surgery and the degree of subluxation did not impact the final visual outcome. Intra-operative complication included vitreous hemorrhage (n-1) and lens matter drop (n-1). Post-operative complications were noted in 26.9% of the eyes (n-21/78) with a higher complication rate in the pseudo-phakic group (p-0.00). A second intervention was required in 7.7% of the eyes (n-6/78).Conclusion: Age and degree of subluxation at the time of surgery do not influence the final visual outcome in cases of ectopia lentis undergoing lens extraction surgery. IOL implantation results in better visual outcomes but is associated with a high complication rate.

Prognostic value of Ocular Trauma Score and pediatric Penetrating Ocular Trauma Score in predicting the visual prognosis following ocular injury.

Aim: To assess the role of Ocular Trauma Score (OTS) and Pediatric Penetrating Ocular Trauma Score (POTS) in predicting visual prognosis following ocular injury. Methods: 120 patients, aged 3 to 70 years, with ocular injury, presenting between August 2020 and 2021, who fulfilled the inclusion criteria, were classified using the Birmingham Eye Trauma Terminology System (BETTS). Data regarding age, sex, injury type, location, initial visual acuity, and treatment were recorded. Patients were evaluated using OTS and POTS, wherever applicable, to predict visual prognosis. Follow-up was done for 6 months post-treatment to compare the predicted and actual visual outcome.Results: 120 patients (96 males and 24 females) were included in the study. The mean age was 17.2 ± 14.7 years (range 3 to 70 years). 91.6% patients included were under the age of 40 years. Blunt trauma (n=62) was slightly more common. 80 patients (66.67%) reported to the hospital after 48 hours of injury. 34 patients (28.33%) had traumatic cataract alone and IOL implantation was done as a primary procedure. In 20 patients (16.67%), lens aspiration was done primarily, with secondary IOL implantation. Six months after the treatment, the BCVA in the open globe injury patients was 20/ 200 or better in 36 patients (75%) and 20/ 40 or better in 18 patients (37.5%). Amongst the closed globe injuries, 48 patients (66.67%), had a BCVA 20/ 200 or better, while 32 (44.44%) had a BCVA of 20/ 40 or better. Conclusion: OTS is a reliable predictor of final visual outcome, both in blunt and penetrating injuries. The POTS shows gross underestimation of final visual outcome.Abbreviations: BETTS = Birmingham Eye Trauma Terminology System, POTS = Pediatric Penetrating Ocular Trauma Score, OTS = Ocular Trauma Score, OGI = Open Globe Injury, HM = Hand Movement, NLP = No Light Perception, LP = Light Perception, CGI = Closed Globe Injury, VA = Visual Acuity, BCVA = Best Corrected Visual Acuity, IAP = Indian Academy of Pediatrics, IOL = Intraocular Lens, IGATES = International Globe and Adnexal Trauma Epidemiology Study, IOP = Intraocular Pressure, CART = Classification and Regression Tree, USA = United States of America

Pediatric traumatic cataracts: 10-year experience of a tertiary referral center

BackgroundThis study aimed to evaluate the factors influencing final visual acuity in pediatric traumatic cataracts.MethodsData of patients who presented with traumatic cataracts were reviewed retrospectively. We evaluated age at trauma; gender, trauma type, cause, and zone; duration between the time of trauma and cataract surgery; surgical method used; time, location, and type of intraocular lens (IOL) implantation; initial and final best corrected visual acuity (BCVA); amblyopia rate; and complications.ResultsIn all, 61 eyes of 59 patients aged < 16 years with cataracts after trauma were included. The mean age of the children was 7.2 ± 3.9 years. Primary IOL implantation was performed in 70.9% of eyes. The BCVA was 0.7 LogMAR or better in 5.9% of the 49 eyes in which the visual acuity could be measured at the time of trauma and in 69.1% of 55 eyes in which it could be measured after treatment. Evaluation of factors potentially influencing the final visual acuity revealed that eyes that had undergone posterior capsulotomy (PC) and anterior vitrectomy (AV) during cataract surgery had significantly better final visual acuity compared with eyes that did not undergo these procedures.ConclusionsIn children with posttraumatic cataracts, final visual acuity was not affected by patient age and gender; trauma type, cause, and zone; duration between the time of trauma and cataract surgery; surgical method used; and time, location, and type of intraocular lens (IOL) implantation. Improvements in the final BCVA could be seen only by PC + AV combined with lens aspiration with or without IOL implantation. However, this approach of amblyopia treatment needs to be confirmed by more comprehensive and prospective studies.

Bilateral symmetrical spontaneous anterior capsule rupture of the cataractous lens in a child

We report the management of a rare case of bilateral, symmetrical, and spontaneous anterior lens capsule rupture with total soft cataractous lens in a 7-year-old child. The patient had no other predisposing factors or systemic associations. Bilateral lens aspiration was done through the fibrosed capsular opening, which behaved like a stable capsulorhexis and hydrophobic intraocular lens was implanted. At 6 weeks follow-up, the patient had good visual outcome without any astigmatism. Although capsule rupture is reported in trauma, Alports syndrome or in hypermature cataracts, to our best knowledge this is the first case report of bilateral symmetrical spontaneous anterior capsule rupture in an otherwise normal child.

Visual Outcome Of Paediatric Traumatic Cataract In Paediatric Ophthalmology Department Of A Tertiary Care Hospital.

Paediatric traumatic cataract is one of leading treatable cause of childhood blindness. The purpose of this study is to analyse number of avoidable blindness in children and to access final visual outcomes, causative factors, strategies for the prevention and management. One hundred and twenty patients of ocular traumatic cataract age between 2 months to 14 years were treated in Department of Paediatric Ophthalmology from April 2019 till April 2020wasprospectivelyreviewed. Data included age, gender, time of presentation, type of injury, anterior segment with fundus examination, time and type of surgery, visual outcome at presentation and final visual outcome. Visual acuity was assessed by fixation and following, Snellen's chart according to patient's age. Some patients underwent for lens aspiration and rest underwent for lens aspiration, posterior capsulotomy and anterior vitrectomy followed by intraocular lens implantation under general anaesthesia. Patients who lost follow ups for two months were not included in study. Analysis of data was done using SPSS for window version 24.0. One hundred and twenty eyes operated for traumatic cataract among which 64 (53.34%) patients were males and 56 (46.66%) were females. The average age of patients was 7.8 years with traumatic cataract. Initial Uncorrected visual out come at the time of presentation ranged from 6/60 to light perception. 15 %of children with traumatic cataract had post-operative final visual outcome of better than 6/18. The commonest cause of ocular injuries in our pediatric ophthalmology department was domestic, mostly in 5-9 years of age with greater number in males. In traumatic cataract extraction final visual outcome depends on initial visual outcome, source and type of injury, duration of presentation, duration of surgery and complications.

Early lens aspiration with posterior chamber intraocular lens and capsular tension ring in microspherophakia to avoid lens-induced complications.

PURPOSE:To report the surgical outcome of early lens aspiration, posterior chamber intraocular lens (PC IOL), and capsular tension ring (CTR) in a case series of microspherophakia (MSP) and secondary glaucoma.METHODS:Case series of 18 eyes of MSP cases presented with lenticular myopia and secondary glaucoma that underwent early lens aspiration, PC IOL and CTR by one ophthalmologist. Baseline, long-term postoperative outcomes and complications were documented.RESULTS:All cases underwent successful surgery with lens aspiration PC IOL implantation and CTR insertion without intraoperative complications. One of the 18 cases was a delayed referral which had broad anterior synechiae and following lens aspiration developed corneal decompensation. In one eye, CTR implantation was not possible hence, lens aspiration with scleral fixation (SF) of 3 piece IOL was performed (excluded from the analysis). Overall there was an improvement in visual acuity (from 0.3 ± 0.1 to 0.2 ± 0.2 LogMar, P = 0.006), intraocular pressure (IOP), and most notably, deepening of the anterior chamber. Some cases required subsequent glaucoma surgery to control IOP. After a long duration of follow-up, all cases had stable capsular lens complex and no capsular phimosis.CONCLUSION:Early Lens aspiration with CTR and PCIOL alone in MSP with lens subluxation has a significant impact on the patient's quality of vision, deepening the anterior chamber and preventing complications or poor outcomes. In addition, good capsular-lens complex stability and absence of capsular phimosis or phacodonesis on long-term follow-up were obtained.