Pediatric traumatic cataract intraocular lens implantation in 28 cases is in the developmental stage, aged 3 to 13 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 usually monocular, and after traumatic cataract extraction, due to excessive anisometropia in both eyes, they cannot wear glasses or contact lenses to correct visual acuity because it easily causes complications in children. To improve eyesight, prevent amblyopia, and establish binocular single vision, intraocular lens implantation for children with traumatic cataracts is the best choice. However, since the child's eye is still developing, the axial length continues to increase. The degree of intraocular lens implantation and the age at implantation are key factors. Jia Shuguang discussed this issue from the anatomical development angle of the eye and found that corneal refractive power, anterior chamber depth, lens thickness, and axial length stabilize after the age of 9 in children aged 3 to 5 years. That is, children aged 3 years have conditions for artificial lens implantation. Before the age of 9, intraocular lens implantation in normal eyes uses adult degrees, then appropriate glasses can be given to correct vision. After the age of 10, direct implantation of an intraocular lens with a suitable degree can be performed. In this group of 28 patients older than 3 years, who met the conditions for intraocular lens implantation, the adult degree was chosen, generally ranging from +18.0D to +22.0D, to enable 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 reduce the psychological and economic burden on the patient.
If the lens capsule ruptures and cortical overflow enters the anterior chamber or if the lens capsule is intact but the lens cortex becomes completely opaque, phacoemulsification and intraocular lens implantation can be performed during corneal laceration suturing. If the anterior lens capsule rupture is small and cortical overflow does not enter the anterior chamber but only partially turbid, surgical operation is performed if the lens opacity significantly affects eyesight after corneal wound suture. If there is corneal injury or infection, intraocular lens (IOL) implantation may be considered. Whenever possible, the IOL should be implanted in the capsular bag position, which is more stable and closer to anatomical and physiological requirements. In case of posterior capsular rupture, the intraocular lens can be fixed by ciliary sulcus suture when serious.
The main complications after pediatric cataract surgery are inflammatory responses and posterior capsular opacification. Children have highly active lens epithelial cells, leading to strong postoperative inflammatory reactions with fibrin exudation that lasts for a long time, making posterior capsular opacification more likely to occur. Posterior capsular opacification rates in children postoperatively are significantly higher than in adults. Its mechanism involves residual lens epithelial cells, iris pigment cells, and macrophages stimulated by inflammation, causing cell proliferation and fibrosis. Therefore, the cortical lens should be cleaned as much as possible during the operation. The operation should be gentle to reduce unnecessary procedures, avoiding depigmentation on the iris surface and minimizing postoperative membranous barriers. Once posterior capsule opacification affects vision, Nd: YAG laser incision can be used to restore vision rapidly.
Due to the specific nature of pediatric intraocular lens implantation with more severe uveal reactions compared to adults, especially in traumatic cataracts, posttraumatic inflammatory responses in children should be treated systemically with antibiotics and corticosteroids to control inflammation after surgery. Local and systemic corticosteroids should be applied daily postoperatively, maintaining pupillary activity through mydriasis. Posterior uveal reactions can be controlled in this way.