Electric Cataract Removal In A Child Followed By Corneal Decompensation And Macular Edema Resulting In Perforating Keratoplasty - A 40 Years Follow-Up

The aim of our case report is to present the subsequent complications following electric

cataract removal with implantation of iris fixated intraocular lens (IOL) in a child, complicated by

corneal decompensation during a long-term follow-up. Macular edema and lamelar

keratoplasty preceded the perforating keratoplasty. 

The combination of complicated cataract removal in a childhood and the temporary benefit of iris fixated IOL means uncertainty in the long-term visual outcomes.     

A 10-year old boy suffered an electric injury in 1980 while rescuing a stork from electricity pylon. The cataract removal and implantation of iris fixated IOL (Sputnik) in both eyes was performed in 2 months. The corneal decompensation of left eye (LE) resulted in lens removal 32 years later. Perforating keratoplasty was performed in LE, but refractory secondary glaucoma caused the decrease of vision to light perception. The visual acuity of right eye (RE) was 0.6 Snellen decimal at the time. The macular edema was detected in RE 37 years after the cataract extraction, which was treated by repeated parenteral methylprednisolon pulses. The corneal decompensation of RE 2 years later (in 2019) further decreased the vision to light perception. The lamellar keratoplasty was performed (Descemet stripping endothelial keratoplasty; DSAEK) and the vision improved to 0.1. However, a year later (in 2020) the corneal decompensation and relapse of macular edema of RE decreased the vision to light perception again. The perforating keratoplasty with iris fixated IOL removal was performed in a same year 2020. This surgery was combined with pars plana vitrectomy with removal of calcificated remains of the lens in the periphery blocking the iris coloboma. The visual acuity of the only eye (RE) is 0.2 with aphakic correction. The macula is without edema, but destruction of outer retinal stratification due to long lasting and relapsing macular edema causes the permanent visual impairment. 

The cataract is the most frequent complication following the electric injury. However, in childhood the uncomplicated cataract removal remains a challenge. The iris fixated IOL is a time-limited refractive solution, resulting in corneal decompensation emerging several decades later. This case report may raise the question, if we could offer any optimal resolution in a field of child cataract surgery with actual know-how and modern technical equipment to avoid the complications as macular edema or corneal decompensation in the future.