Long-term results of secondary intraocular lens implantation in children under 30 months of age

Marta Morales,Newton Kara-Junior,Alicia Serra,Camila R Koch

doi:10.1038/s41433-018-0191-3

Abstract

PurposeTo report the long-term outcome of early secondary intraocular lens (IOL) implantation following congenital cataract extraction in a large number of eyes.MethodsData of aphakic children under 30 months of age who underwent secondary IOL implantation and had at least one year of follow-up after the surgery was reviewed. In all of the patients, a foldable three-piece acrylic IOL was implanted in the ciliary sulcus by the same surgeon using the same technique. The database studied included refractive and visual acuity (VA) outcomes and complications.ResultsFifty patients (75 eyes) were included. The average age at the time of cataract extraction was 94.20 ± 44.94 days and 20.7 ± 6.0 months in the secondary IOL implantation. After 82.32 ± 48.91 months, the VA was 0.58 ± 0.35 LogMAR and the spherical equivalent was −2.20 ± 4.19 D. There was a negative correlation between a longer follow-up period and myopia at the SE measured (P = .001). The most frequent complications included glaucoma and corectopia. Performing the secondary IOL implantation ≤ 20 months of age was not a risk factor for glaucoma development (P = 0.095).ConclusionSecondary IOL implantation under 30 months of age is an option for children with unsatisfactory management of the optic treatment. A predictable IOL power calculation and satisfactory visual outcomes compared to results of later secondary IOL implantation are possible.

Highlights

Despite improvements in pediatric cataract surgery, the intraocular lens (IOL) power calculation is still the greatest challenge in young children
During the first six month of life, the increase in axial length and the change in corneal curvature are faster, making the selection of the IOL power and the prediction of myopia shift more accurate after this period [1,2,3]
The mean time elapsed between the cataract extraction and the secondary IOL implantation was 17.73 ± 5.87 months

Summary

Introduction

Despite improvements in pediatric cataract surgery, the intraocular lens (IOL) power calculation is still the greatest challenge in young children. There is no consensus on the right time to perform primary IOL implantation [5]. Correction of aphakia is the most critical component to prevent the development of amblyopia. It must be treated by having the child wear either contact lenses or glasses fulltime whenever awake [7, 8]. Most research has shown satisfactory secondary IOL implant results in preschoolers [11,12,13], but the optimal time to perform it in aphakic children is uncertain

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Results

Discussion

Conclusion