Majority of children in Infant Aphakia Treatment Study developed strabismus by 1 year postop

Issue: May 10, 2012

Erick D. Bothun

SAN ANTONIO — Strabismus developed in the majority of children by 1 year postoperatively in the Infant Aphakia Treatment Study, regardless of whether an IOL or a contact lens was used to treat aphakia, a speaker said here.

Perspective from David A. Plager, MD

Strabismus is commonly associated with unilateral cataract surgery in infants, and some literature has suggested that there may be a protective effect in children when an IOL is implanted, Erick D. Bothun, MD, said at the American Association for Pediatric Ophthalmology and Strabismus meeting.

"We decided to look at the characteristics of strabismus for infants in the Infant Aphakia Treatment Study," he said.

The Infant Aphakia Treatment Study is a National Eye Institute-sponsored ongoing randomized multicenter clinical trial of children with two arms of treatment in the management of aphakia: contact lens or implantation of an IOL. Implantation of an IOL in a child is considered off-label use.

At enrollment, 28 of the 114 infants (24.6%) had strabismus. The prevalence of strabismus at baseline did not differ between the treatment groups.

"We looked at the proportion of patients who developed strabismus over time up to their 1-year postoperative visit," Dr. Bothun said.

The crux of the presentation was that, in the entire cohort, by 1 year postoperatively, 70% of children in the study developed strabismus, starting with the 25% at baseline, he said.

"Intraocular lens placement certainly did not eliminate strabismus to 1 year postoperatively for kids in the Infant Aphakia Treatment Study. And strabismus developed less frequently in infants whose cataract was removed prior to 49 days of age compared to the other cohort," Dr. Bothun said.

Disclosure: Dr. Bothun has no relevant financial disclosures.

Perspective

David A. Plager, MD

Physicians managing amblyopia after unilateral congenital cataract surgery in early infancy strive to balance an aggressive patching regimen designed to minimize amblyopia against the widely accepted belief that maximizing binocular viewing time (no patch) may decrease the incidence of strabismus. Such a balance was built in to the protocol for the IATS.

The results reported by Bothun et al on behalf of the IATS study group show that the placement of an IOL at the time of surgery does not impact the incidence of strabismus found in this patient population. The high incidence of strabismus in both treatment groups — IOL and no IOL — further shows that strabismus remains a very likely, albeit not invariable, sequela of unilateral congenital cataract regardless of treatment modality. It is possible that the observed incidence of strabismus will rise even higher as follow-up of this patient group extends past the first year.

David A. Plager, MD

Indiana University Medical Center, Indianapolis

Disclosures: Dr. Plager has no relevant financial disclosures.