Stintzy (i966), in a review of 450 cases of eye injuries, mostly unilateral, in children, reported the development of cataract in 26 per cent. Traumatic cataract, if not complicated by severe damage to other structures of the eye and if successfully treated by surgery, presents the surgeon and the child with the problems of unilateral aphakia. The optical correction of the latter is the crux of successful functional recovery.In the adult aphakic patient visual acuity can be and usually is preserved for long periods of life, even without optical correction. Also binocularity has been demonstrated in adults in whom a contact lens or lens implant has been fitted several decades after lens injury. This, however, does not hold true in cases of lens injury in infancy and childhood. The younger the child and the longer the interval between injury and clearing of the pupil, the more chance there is of irreparable loss of visual acuity and of binocularity. Such loss is certain to occur when no correction at all is prescribed or when the eye is equipped only with a spectacle glass (Juler, I92 1; McKinna, I96I).
Contact lensesThe development of contact lenses seemed to offer more hope to the unilateral aphakic child, and many reports have appeared, including those of Ridley (I953), Spaeth and O'Neill (1960), Blaxter (i 963), Ruben (i 963), Magnard, Hugonnier-Clayette, Hugonnier, and Bourelly (i964), Riehm and Thiel (I965), Bronner (i966), Bonnet, Gerhard, and Massin (I966), and Oifret, Coscas, and Huet (I967).The corneal contact lens is most often used for the purpose to-day, but high plus corneal lenses tend to downward displacement, thus causing vertical diplopia (Bronner and Gerhard, 1958), and the corneo-scleral lens is preferred by many authors (Ridley, 1953; Bronner and Gerhard, I958; Spaeth and O'Neill, I960; Blaxter, I963; Lake and Manson, I964; Bonnet and others, I966). Because of their increased weight, however, the latter also can give rise to vertical phoria and diplopia.Although we have fitted young children and even infants with contact lenses (as did Bronner (i966) at 8 years; Offret and others (i967) at 5 years. Several authors mention major difficulties even in children above these age limits. Toleration of the lens largely depends on the cooperation not only of the child, but also of the parents. Many unilateral aphakic patients give up wearing their contact lens sooner or later. Bonnet and others (I966) found that, of 308 adult unilateral aphakics, nearly 8o per cent. had given up wearing their contact lens after io years. There is no reason to suppose that results in
