Intraocular lens implantation for traumatic cataract in children in East Africa

PURPOSE: To review the visual outcomes and complications after intraocular lens (IOL) implantation in children with traumatic cataract in sub-Saharan Africa, where contact lenses for unilateral aphakia are impractical in most patients. SETTING: PCEA Kikuyu Eye Unit, Nairobi, Kenya, East Africa. METHODS: All children younger than 16 years having IOL implantation for traumatic cataract between February 1993 and December 1998 (215 eyes) were retrospectively reviewed. Complications and visual outcomes were evaluated. RESULTS: The study group comprised 147 boys and 68 girls. The median interval between injury and cataract surgery was 8 weeks. The most common causes of injury were stick (36.3%) and thorn (10.7%). Extracapsular cataract extraction with IOL implantation was performed in all patients. The most frequent early complication was fibrinous uveitis in 110 eyes (51.2%). One hundred sixty-seven eyes (77.7%) had 1 month or more follow-up. Of those, 108 eyes (64.7%) had a best corrected visual acuity of 20/60 or better. Twenty-one eyes (12.6%) had a visual acuity of worse than 20/200, with the most common causes being amblyopia (9/21) and retinal detachment (5/21). Amblyopia was found in 42 of 108 (38.9%) children aged 8 years or less at the time of injury. Eyes with the IOL in the capsular bag were significantly less likely to require subsequent capsulotomy (P <.01) during the 2-year follow-up. CONCLUSION: The results indicate that posterior chamber IOLs can be safely implanted by experienced surgeons in most children older than 2 years with traumatic cataract and should be the standard of care throughout the world.