Intraocular Lenses for Infants With Aphakia

Abstract


 This systematic review examined intraocular lens implantation in patients aged 12 months or younger at the time of surgery compared with patients aged 12 months or younger with aphakia treated with contact lenses or glasses. It also examined intraocular lens implantation in patients aged 12 months or younger at the time of surgery (i.e., infants) compared with patients older than 12 months up to 12 years of age at the time of surgery (i.e., children).
 In total, 18 studies (3 randomized controlled trials and 15 nonrandomized studies) were identified that answered the clinical questions relevant to this review. No relevant studies were identified to inform the cost-effectiveness questions.
 Visual outcomes (i.e., visual acuity) did not seem to differ between patients aged 12 months or younger at the time of surgery who received intraocular lens implantation and in patients with aphakia treated with contact lenses or glasses. Parenting stress was higher in parents of infants who received intraocular lens implantation at 3 months after surgery compared with parents of infants who were treated with contact lenses; however, this difference was not maintained at 1 year after surgery.
 In 1 study that examined intraocular lens implantation at different ages, age did not appear to be a significant prognostic factor in poor visual outcomes (i.e., visual acuity defined as > 0.5 logMAR).
 Regarding safety, infants who underwent intraocular lens implantation experienced more frequent occurrences of complications, such as visual axis opacification, compared with infants with aphakia treated with contact lenses or glasses; therefore, more reoperations to remove the opacification were required. Many infants with aphakia who did not receive intraocular lens implantation eventually required the surgery when they got older.
 There were limited statistical comparisons available for safety outcomes for intraocular lens implantation in infants at different ages. Overall, the incidence in adverse events was similar between infants and children, except for the number of additional surgeries. In the identified literature, younger patients received more additional surgeries than older patients.
 The risk of bias in the included studies was high. There were many methodological concerns, including selection bias, reporting issues, statistical issues, and study designs with high risk of bias, such as retrospective cohort studies.
 Family input regarding patients’ and caregivers’ experiences included reports of stress related to the use of contact lenses and stress about outcomes of the cataract removal and/or intraocular lens implantation and the effect on the child, and emphasized timely treatment to ensure optimal development of the child.