Pediatric traumatic cataract intraocular lens implantation in 28 cases is in the developmental stage, age 3 to 3 during a period of rapid growth, and L3 is the slow growth phase. If cataract formation occurs during this sensitive period, deprivation amblyopia and binocular vision dysfunction will occur. Therefore, surgical treatment is necessary. Children with traumatic cataracts are monocular, and after traumatic cataract extraction, due to excessive anisometropia in both eyes, glasses cannot be worn, and contact lens wear cannot correct visual acuity because children do not fit easily and complications may arise. To improve eyesight, prevent amblyopia, and form binocular single vision, intraocular lens implantation is the best choice for children with traumatic cataracts. However, since the eyes of children are fat #183;75# yo, and the axial length increases continuously, the degree of intraocular lens implantation and the age at implantation are key factors. Jia Shuguang discussed this issue from the anatomical perspective of eye development and found that the corneal refractive power, anterior chamber depth, lens thickness, and axial length of children aged 3-5 years reach adult levels after age 9. That is, children aged 3 years meet the conditions for artificial lens implantation. Before the age of 9, intraocular lenses of normal adult degrees can be implanted in the eyes, then appropriate glasses can be used for correction. After the age of 10, direct implantation of appropriately graded intraocular lenses can be performed. In this group of 28 patients over 3 years old, the conditions for intraocular lens implantation were met, so adult degrees were chosen, generally between +18.0D and +22.0D. This allows children to achieve emmetropia as adults. When conditions permit, intraocular lens implants should be performed as much as possible to reduce ocular tissue trauma during surgery and alleviate the psychological and economic burden on patients.
If the lens capsule ruptures and cortical overflow enters the anterior chamber or if the lens capsule remains intact but the lens cortex becomes completely opaque, phacoemulsification of cataracts and intraocular lens implantation can be performed during corneal laceration suturing. If the anterior lens capsule rupture is small and the cortex does not overflow into the anterior chamber, but part of the cortex becomes turbid, surgical operations can be performed if corneal wound suturing significantly affects vision. If corneal injury or infection occurs, intraocular lens IOL implantation can be considered. The position within the capsular bag should be chosen for implantation when possible, as it is more stable and meets close anatomical and physiological requirements. In cases of posterior capsule rupture, intraocular lens suture fixation in the ciliary sulcus can be seriously considered.
The main complications after pediatric cataract surgery are inflammatory responses and posterior capsule opacification. Children have highly active lens epithelial cells, strong postoperative inflammatory reactions, fibrin exudation appearances, long-lasting effects, and easy occurrence of posterior capsule opacification. Posterior capsule opacification rates in children after surgery are significantly higher than in adults. Its mechanism involves residual lens epithelial cells, iris pigment cells, and macrophages stimulated by inflammation, leading to cell proliferation and fibrosis. Therefore, the cortex of the lens should be cleaned as much as possible during the operation, which should be gentle to reduce unnecessary operations, thereby avoiding iris surface depigmentation and minimizing postoperative membranous barriers. If posterior capsule opacification affects vision after cataract surgery, Nd:YAG laser incision of posterior capsule opacification can rapidly restore visual acuity. Due to the specific uveal reaction being more severe in pediatric intraocular lens implantation compared to adults, especially in traumatic cataracts, heavier post-traumatic inflammatory responses in children should be treated systemically with antibiotics and corticosteroids to control inflammation after surgery. Postoperative daily local and systemic application of corticosteroids, along with maintaining pupillary activity through mydriasis, can control posterior uveal reactions.