Pediatric Ocular Trauma: Delayed IOL Implantation Shows Better Visual Outcomes

HELSINKI — A retrospective study presented at the European Society of Cataract and Refractive Surgeons winter meeting suggests that delayed implantation of intraocular lenses (IOLs) may lead to improved visual outcomes in children with open globe injuries and active inflammation, compared to primary IOL implantation at the time of cataract surgery. The study was conducted at a tertiary hospital in Western India.

Study Details

The study included 78 eyes of 78 children under the age of 16 with both open and closed globe injuries. The average age of the children was 7 ± 1.5 years, with approximately 55% being male. Injuries were classified as open globe in 52 patients (66.7%), and 61.5% of cases were restricted to zone one.

All patients underwent corneoscleral tear repair, with additional procedures performed as needed. Pars plana vitrectomy was performed in seven eyes, and cataract surgery was performed in 30 eyes. The mean visual acuity at presentation was 1.4 logMAR (approximately 20/500).

Key Findings

Post-surgical best corrected visual acuity improved to 0.8 logMAR (approximately 20/125) six months after intervention. Researchers compared visual acuity outcomes between patients who received primary IOL implantation during cataract surgery and those who underwent staged IOL implantation at a later date.

“The patients in whom we performed secondary IOL implantation had a better outcome as compared to the patients who had IOL implantation in the primary setting,” stated Nikhil M. Gandhi, MD, the study’s presenter.

Surgical Approach and Considerations

Dr. Gandhi emphasized the importance of early intervention and careful surgical planning in these cases. He recommended performing cataract surgery within 1 to 3 days of injury, but delaying IOL implantation for at least 3 weeks to 1 month to allow for resolution of inflammation.

“When a patient comes to us, within 1 or 2 days, maximum 3 days, we do the primary surgery. After that, we wait for at least 3 weeks to 1 month for the inflammation to go down. At that point, we implant the lens,” Dr. Gandhi explained.

The delay in IOL implantation as well provides time for the child to prepare for a second general anesthesia, as topical anesthesia is not suitable for traumatic cataract surgery in children.

Parent Counseling

Dr. Gandhi highlighted the importance of thorough parent counseling, acknowledging that expectations can be unrealistic. He stressed the need to inform parents that outcomes are not always certain and that the desired result may not be achieved.

Source

Gandhi N. Paediatric ocular trauma – A retrospective study. Presented at: European Society of Cataract and Refractive Surgeons winter meeting; March 6-8, 2026; Helsinki.

Disclosure: Dr. Gandhi reports no relevant financial disclosures.