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Primary IOL implantation an option for managing pediatric cataract

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HONOLULU — Primary IOL implantation to treat and manage cataract in children younger than 1 year of age should be considered, according to Emi Sanders and William F. Astle, MD, FRCSC, who presented a poster on the topic at the Association for Research in Vision and Ophthalmology meeting here.

"This study demonstrates that primary IOL implants in infants under the age of 1 year are safe and effective long-term, with no serious adverse events occurring that could threaten a young child’s vision. This study demonstrated better visual rehabilitation with IOLs than in children left aphakic under age 1, and with virtually no glaucoma. Children left aphakic in this cohort were more than 20 times more likely to develop glaucoma than children with IOLs. While still considered controversial in many circles, improvements in both surgical techniques and instrumentation demonstrate that IOL implants in children under the age of 1 may be a viable, safe and effective procedure," Astle said.

In the retrospective chart review, 54 eyes of 39 patients who underwent primary IOL implantation were compared with 19 eyes of 16 patients who were initially left aphakic, with eight eyes undergoing secondary IOL implantation.

Eyes in the aphakic group were 20 times more likely to develop glaucoma than eyes in the primary IOL group, 44.4% vs. 1.9%, respectively. The aphakic group was twice as likely as the primary IOL group to need at least one additional surgery, including ptosis repair, LASEK, Ahmed valve and goniotomy.

Regarding visual acuity, average last recorded visual acuity was 20/125 in the primary IOL group and 20/200 in the aphakic group.

No serious adverse events were recorded in the primary IOL group, and there was no difference between groups with regard to development of membrane. – by Patricia Nale, ELS

Reference:

Sanders E, et al. Safety and efficacy of primary intraocular lens implantation in children under 1 year of age. Presented at: Association for Research in Vision and Ophthalmology annual meeting; April 28-May 3, 2018; Honolulu.

Disclosure  The authors report no relevant financial disclosures.