Intraocular lens implantation in infants and toddlers in 2020

Abstract

ABSTRACT Introduction Intraocular lens (IOL) implantation in an infant has been extensively debated with Infant Aphakia Treatment Study (IATS) (unilateral cataract; operated ≤7 months of age) and IOLunder2 trial (unilateral and bilateral cataracts; operated ≤2 years) strongly discouraging IOL implantation in infants and toddlers due to higher adverse events over 5 years. Areas covered Newer studies from developing countries demonstrated a lower incidence of complications, doubting the extrapolation of the results of a randomized controlled trial in developed countries to that of developing countries that face various multidimensional challenges including social, economic and attitudinal characteristics of caregivers. We studied the evidence supporting and against IOL implantation in infants and toddlers and conclude that implantation of IOL in these patients is a viable option, especially in developing countries due to lower rates of complications in carefully selected cases. Expert opinion This review suggests that an arbitrary age of six months is inadequate to decide whether to implant an IOL and requires a more comprehensive approach. New guidelines for patient selection for primary IOL implantation in infants and toddlers have been proposed, which include ocular factors such as biometry, coexisting ocular comorbidities, intraoperative risk factors, surgeon’s experience, and socio-economic considerations.