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Phakic IOL a viable treatment option for pediatric anisometropic amblyopia
J Refract Surg. 2011;27(7):494-501.
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Phakic IOL implantation provided long-term improved vision in select children with anisometropic amblyopia, a study found.
“Considering the outcomes obtained in the current study, we can conclude that [phakic] IOL implantation appears to be an effective option in treating severe cases of anisometropia leading to amblyopia in children in whom conventional treatment methods are not satisfactory and laser refractive surgery is not possible,” the study authors said.
The retrospective study included 10 eyes of 10 children with high anisometropic amblyopia who did not respond to conventional treatments such as spectacles, contact lenses and occlusion therapy. Mean patient age was 8 years (range: 2 years to 15 years).
Nine eyes were implanted with an Artisan anterior chamber iris-fixated phakic IOL (Ophtec). One eye received a PRL posterior chamber phakic IOL (CIBA Vision). No intraoperative complications were reported.
All patients underwent occlusion therapy after surgery. Three patients required strabismus surgery to attain ortophoria and maintain binocular vision.
Mean preoperative logMAR uncorrected distance visual acuity was 1.10, and mean preoperative corrected distance visual acuity was 0.84.
Results showed that mean postoperative logMAR uncorrected distance visual acuity was 0.90 at 6 months, 0.61 at 2 years and 0.65 at 5 years. Mean corrected distance visual acuity was 0.78 at 6 months, 0.39 at 2 years and 0.36 at 5 years.
Nine patients gained more than three logMAR lines of corrected distance visual acuity; the one patient implanted with a posterior chamber IOL gained only one line. No patients lost lines of corrected distance visual acuity.
A multicenter, prospective, randomized clinical study of phakic IOL implantation in children of various ages is warranted, the authors said.
The use of phakic IOLs in children is a practical element in any discussion of pediatric refractive surgery as many of these patients have refractive errors outside of the range of excimer lasers. Phakic IOLs also give the advantage of being removable and providing better optics. When considering pediatric refractive surgery it must be noted that these surgeries are done to treat a different disease than in the adult population. Adults undergo refractive surgery to treat refractive error. We perform pediatric refractive surgery to treat amblyopia. The goal is to offer the potential for improved vision in an eye or eyes destined for a lifetime of poor best corrected acuity. While long-term safety data will take decades to collect, studies such as this show that poor vision from refractive amblyopia can be improved with phakic IOL implantation and that the 5-year safety data appears acceptable.
– Erin D. Stahl, MD
OSN
Pediatrics/Strabismus Board Member
Disclosure: No products or companies are
mentioned that would require financial disclosure.