Successful surgical rehabilitation of children with traumatic corneal laceration and cataract

Objective: To evaluate the visual and refractive outcome of corneal transplant surgery, cataract extraction, and intraocular lens (IOL) implantation in children with traumatic corneal laceration and cataract. Design: Retrospective, noncomparative case series. Participants: Five patients, 7 years of age or younger, who underwent penetrating keratoplasty, cataract extraction, and IOL implantation for traumatic corneal laceration and cataract were identified. Main Outcome Measures: Each case was analyzed retrospectively for the following factors: preoperative findings; surgical technique, including management of the posterior capsule; measurement of axial length and keratometry; calculation of IOL power, style, and type of IOL implanted; graft clarity; final visual acuity; and final refraction. Results: The five children ranged from 3 to 7 years of age at the time of trauma. All had primary repair of their injury before referral. Each patient was observed for more than 2 years. Each had a posterior chamber IOL placed in the sulcus. After surgery, no severe complications were observed. The preoperative visual acuity ranged from 20/400 to light perception. After surgery, all five patients had clear grafts and an improved visual acuity ranging from 20/20 to 20/400. The final spherical refraction in each patient was within 3.75 diopters (D) of plano, with 1.50 to 3.25 D of cylinder. Conclusions: Successful surgical rehabilitation was accomplished in these patients. Despite their young age and the difficulty in determining IOL power, combining surgery and aggressive amblyopia therapy resulted in visual rehabilitation with refractions approaching emmetropia.