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One-year data show no visual benefit for primary IOL implantation in pediatric cataract patients
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KIAWAH ISLAND, S.C. — Early returns from the Infant Aphakia Treatment Study indicate no difference in vision at 1 year in pediatric cataract patients who received an IOL compared with patients who received a contact lens after cataract removal.
 M. Edward Wilson Jr. |
The result was not entirely unexpected, M. Edward Wilson Jr., MD, one of the members of the study's steering committee, said at Kiawah Eye 2010. Pilot studies undertaken before the Infant Aphakia Treatment Study was launched indicated that IOLs may improve vision over contact lens wear, but may also cause increased complications. In addition, the second phase of the study, in which contact lens wearers would be implanted with an IOL, has not been initiated.
"There was not a statistically significant difference in visual acuity in the contact lens and non-contact lens group," Dr. Wilson said. "However, as expected, complications were higher in the non-contact lens group."
Patients in the IOL group more frequently returned for a secondary operation after primary implantation, mostly to remove material that had dislodged due to a Soemmering's ring within the first 6 months, Dr. Wilson said. However, a second surgery was not a deterrent to visual development, he said.
The Infant Aphakia Treatment Study has still not answered its primary objective: whether delayed or primary IOL implantation is more beneficial. Patients will be continued to be followed for a total of 5 years, Dr. Wilson said.
The Infant Aphakia Treatment Study was developed to attempt to determine whether primary IOL implantation or aphakic contact lenses were the better alternative from the age of 4 weeks to 7 months. While the study concludes that there is not a statistically significant difference in the contact lens vs. IOL group, the complications were higher in the latter, including the need for secondary surgeries. The take home message is that we should understand that this study is still in its “infancy” as these patients will be followed for 5 years before a definitive determination of visual success will be made. In addition, we welcome the start of the second phase of the study where secondary IOLs will be implanted in aphakic contact lens wearers. The 12 centers around the country should be commended for their efforts in this project.
– Robert S. Gold, MD
OSN
Pediatrics/Strabismus Section Editor
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