Controversial

IOL implantation is probably safe in children older than 1 year. It is not clear how the IOL power should be calculated/predicted in an eye that is still growing, especially if primary implantation is planned [15].

• The standard method of calculating the IOL power results in overcorrection if the child is under 8 years, due to the myopic shift with the eye's normal growth [31]. Undercorrection, gradually decreasing from +6 D at age 1 year to plano at age 7 years, has been suggested as a resolution to the controversy [19]. Patients must undergo appropriate contact lens fitting and anti-amblyopia therapy until emmetropia ensues.

• Because children are at a higher risk of additional injury, scleral fixation of the IOL should be considered if the zonules are not completely intact.

• The most common early complication after IOL implantation is severe fibrinous anterior uveitis (51%), especially prominent in patients with dark iris [23].

• In eyes with secondary IOL implantation, the IOL is usually placed onto the capsule17 because the capsules have scarred together. In-the-sulcus IOL placement does not appear to have adverse consequences [6, 60].

• The IOL should be acrylic or PMMA (heparin surface-modified), with a rather large (6.5 mm) optic.

• In a major study, trauma was the cause in 73% of children presenting with vitreous hemorrhage [49]. Contusion was slightly more common than open globe trauma (30 vs 25%, respectively).

• The risk of the formation of anterior and/or posterior synechia is higher in the young than in adults. Postoperative anti-inflammatory treatment is even more important in children than in adults. In certain cases the inflammation may have to be fought even intraoperative^8 (see Chap. 2.17).

17 Even if the capsular bag has originally been preserved.

18 i.e., fibrin formation.

• If vitrectomy is performed, the creation of a PVD is crucial. This is a much more difficult (and potentially risky) maneuver in a child's eye than in that of an adult. Intraoperative injection of 0.4 IU autologous plasmin may be helpful [36], but the surgeon has to be ready to abandon the procedure (see Chap. 2.9) if separation of the posterior hyaloid is very difficult.

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