Study compares outcomes of pediatric primary and secondary IOL implantation

Pediatric patients who underwent secondary IOL implantation for pediatric cataract experienced generally worse best corrected visual acuity and a higher risk for developing strabismus than patients who underwent primary IOL implantation, according to a study.

Perspective from M. Edward Wilson, MD

The study included pediatric patients who had undergone cataract surgery between 1999 and 2014. Researchers retrospectively reviewed 220 eyes of 148 patients with a mean age of 6.84 ± 3.45 years at the time of cataract extraction and primary posterior chamber IOL implantation. Patients had a mean age of 8.92 ± 5.12 years at the time of secondary IOL implantation.

According to the study, 180 eyes underwent primary posterior chamber IOL implantation and 40 eyes underwent secondary implantation. At final follow-up, the mean BCVA in the primary group was 0.44 ± 0.33 compared with 0.28 ± .032 in the secondary group (P = .013). Strabismus was diagnosed in 23.73% of patients in the primary group and 30% of patients in the secondary group; the difference was not statistically significant.

“Logistic regression analysis of possible risk factors for the development of strabismus revealed a statistically significant negative relationship between visual acuity and strabismus (P = .048), with lower visual acuity causing more strabismus. There was a significant positive relationship between follow-up periods and strabismus (P = .008), with the development of strabismus increasing as the follow-up period increased,” the researchers wrote. – by Robert Linnehan

Disclosure: The authors report no relevant financial disclosures.

Perspective

M. Edward Wilson, MD

The authors of this study analyzed data from 220 eyes of 148 children implanted with an IOL, either primarily (180 eyes) or secondarily (40 eyes). The children were followed for a mean of 2 years after implantation. The visual acuity outcomes were variable in both groups but better, on average, in the primary IOL group. The authors describe delays in the initial cataract removal and in the secondary implantation as contributing factors to the poorer visual outcomes. Fusion and stereopsis was present in only 10% of the primary IOL group and none of the secondary IOL group. Logistic regression analysis revealed a statistically significant negative relationship between visual acuity and strabismus. Patients with poorer vision and longer follow-up were more likely to have strabismus.

This study highlights some of the many challenges faced by surgeons who operate on children with cataracts. Early detection and treatment, constant attention to optical correction, and long follow-up are needed to maximize visual outcomes. Even then, strabismus commonly develops over time and high-grade binocularity is rarely achieved.

M. Edward Wilson, MD

OSN Pediatrics/Strabismus Board Member

Disclosures: Wilson reports clinical trial participation for Ophtec, Retrophin and Omeros.

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Sources/Disclosures

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Source:

Sefi-Yurdakul N, et al. J Pediatr Ophthalmol Strabismus. 2017;doi:10.3928/01913913-20160926-01.