________________________ ORIGINAL ARTICLES
A Intraocular Lens Fixation in Infants and Small Children
A Vasavada, R Trivedi
Iladevi Cataract & IOL Research Centre &
Raghudeep Eye Clinic,
Ahmedabad, India
Congenital cataract remains a very important and difficult problem to manage. A number of studies have shown that congenital cataract continues to be a significant cause for children registered as partially sighted or blind. The surgeon plays an important, although small, role in its management. The entire team consisting of surgeon, parents, anaesthetist, paedi-atrician, intern, orthoptist, geneticist, and social worker have to prepare for long-term treatment.
From a clinical and surgical point of view, younger children pose special difficulties for the surgeon. Infants are more difficult to manage than toddlers (1-3 years) are, while children older than 5 years are relatively easier to manage.
A variety of measures are available to optically correct aphakia in children, including aphakic glasses, contact lenses and intraocular lenses (IOLs).1 Although aphakic glasses can safely be used for bilateral cataracts and their power can be easily adjusted as the eye elongates, they are not always practical. Aphakic glasses are associated with the disadvantage of optical distortion and are not suitable for unilateral aphakia.
Likewise, contact lenses are safe and their power can be easily adjusted as the infantile eye elongates and they are acceptable for unilateral aphakia. However, they are associated with corneal complications. Long-term care, parents' non-compliance, and economic considerations also make contact lenses an impractical solution to aphakia for most children.
During the past 10 to 20 years, adult cataract surgery has advanced with improved surgical techniques, safer IOLs, and better quality viscoelastic material. These refinements have helped cataract surgeons to produce a technically safe eye for young children. Several recent reports show good results in the short to intermediate term after IOL implantation in paediatric eyes. However, long-term results are still awaited.2-5
IOL implantation avoids many of the complications associated with contact lenses, but does carry its own risk. Surgeons may encounter increased inflammatory response due to implantation of an adult size IOL in small eyes. Although the literature has reported the incidence of posterior capsule opacification to be as high as 100%,6 recent advances in surgical techniques with the aid of primary anterior vitrectomy4 and improved IOL material help to ensure a quieter eye with clear visual axis. Under-correction is a reasonable proposition for managing rapid myopisation in infants and small children.7 In many parts of the world, aphakic glasses and contact lenses are impractical and IOL implantation remains the only realistic option.
In this article, we highlight some surgical tips that are useful for congenital cataract surgery (figures 1 and 2).
Figure 1. Congenital cataract in a child aged 11 months (nuclear and coralliform).

Figure 2. Congenital cataract in a child aged 4 Years (Lamellar Cataract)
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