Implantation in the capsular bag by experienced intraocular lens surgeons, for treatment of cataract in children, may be considered as a valid and secure alternative proposal to contact lenses and epikeratophakia. A comparative preliminary study shows the results of different techniques: primary implantation with secondary posterior YAG laser capsulotomy or implantation and primary posterior capsulotomy with or without anterior vitrectomy.
We have implanted 530 Galand's disc lens in the last 15 months. Stability and self-centering of implant were good when peroperative vitreous pressure was normal and in any case when wound was closed. Pupillary blocks, specific complications of this lens were rare (less than 1%); they can be prevented occurred by simple and adequate protocols.
Operative difficulties and post operative complications after posterior chamber lens implantation are described in 27 eyes with exfoliation syndrome, 8 simple exfoliation syndromes and 19 capsular glaucoma. 14 eyes were operated on by extracapsular extraction and posterior chamber lens implantation in the capsular bag; 13 eyes had extracapsular cataract implantation combined with trabeculectomy. Operative difficulties were due to bad mydriasis and zonular laxity. There was no zonular dialysis. Post-operative visual acuity was between 20/40 and 20/20 in 70% of the cases. There was nos lens luxation. Intercapsular implantation is possible without great risk. The risk of zonular rupture occurs principally during extracapsular extraction. Implants 4 to 12 times Lighter than a cataract human lens do not seem to be dangerous when there is no peroperative zonular rupture.
After the era of antibiotics, a real improvement has been stated in the percentage of endophthalmis following cataract surgery which has fallen from 1% between 1950 and 1977, to 0.2-0.3% now. Since 10 lenses have been implanted, the incidence of acute bacterial endophthalmitis due to pathogenic organisms has not increased. But we now encounter many cases of "cold endophthalmitis", with a lowered symptomatology, a delayed onset, and which are due to organisms of low virulence. Their prognosis can be improved by early vitrectomy combined to intraocular antibiotics in the more severe cases, and by using antibiotics of high intraocular penetration in the milder cases. We report fifteen cases of pseudophakic endophthalmitis. The clinical course was acute in one case, sub acute in eleven cases, and chronic in three cases. In the latter fourteen cases a vitrectomy was performed in 60% of the cases. Aqueous and vitreous taps have found cocci gram + in five cases. Visual results are superior to 1/20 in 2/3 of the cases.
