Primary versus secondary IOL implantation following removal of infantile unilateral congenital cataract: outcomes after at least 5 years

Abstract

To report outcomes after at least 5years' follow-up of consecutive patients at a single center undergoing unilateral congenital cataract surgery during infancy with primary intraocular lens (IOL) implantation at the time of surgery or undergoing secondary IOL implantation later in childhood. The medical records of pseudophakic children who received initial cataract surgery before 7months of age were retrospectively reviewed. Children with acquired cataract, persistent fetal vasculature, congenital glaucoma, or follow-up of <5years were excluded. Mean age at time of cataract surgery was 2.7months in the primary group (n=13) and 1.9months in the secondary group (n=13). Mean age at IOL implantation in the latter group was 4.9±2.2years. Mean age at final follow-up was 10.7±4.2years in the primary group and 8.7±3.0years in the secondary group. Glaucoma surgery was performed in 2 primary group eyes and 1 secondary group eye; it was medically controlled in 2 additional eyes of the latter group. One secondary group eye was diagnosed as glaucoma suspect. Visual axis opacification required surgery in 5 primary group eyes and 2 secondary group eyes before IOL implantation. Unplanned IOL exchange or removal for high myopia was required in 3 primary group eyes and 1 secondary group eye. Strabismus surgery was performed in 3 primary group eyes and 7 secondary group eyes. Median visual acuity at final follow-up was 20/150 in both groups. Refraction at last follow-up was -2.9±3.3 D in the primary and -1.8±2.5 D in the secondary group. Reoperations were common in both groups over long-term follow-up. Close monitoring for glaucoma is also needed in both groups.