Secondary in-the-bag intraocular lens implantation in children who have been aphakic since early infancy

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To report the results of secondary in-the-bag intraocular lens (IOL) implantation compared to secondary sulcus IOL implantation in eyes that received cataract extraction during early infancy. This was a comparative retrospective study. Data were collected for the ages at cataract extraction and at secondary IOL implantation, the length of follow-up, the reasons for IOL insertion, postoperative complications, and pre- and postoperative best-corrected visual acuity. Eyes with less than 6 months of follow-up were excluded from the analysis of postoperative outcome but were included in the rest of the analysis. Thirty-three eyes received in-the-bag secondary IOL implantation at the Storm Eye Institute, Medical University of South Carolina, during the past 10 years and were compared with 21 eyes that received secondary sulcus IOL implantation during the same time period. Both groups had cataract extraction during the first 4 months of life. The 2 groups were comparable in terms of age at secondary IOL implantation, sex, ethnicity, laterality, and eye measurements except for a longer mean axial length for the eyes implanted in the sulcus. The complications were comparable in both groups. The last follow-up best-corrected visual acuity clustered around a median of 20/40 and was not significantly different between the 2 groups or from the median preoperative best-corrected visual acuity of 20/50. Secondary in-the-bag IOL implantation has comparable early results with sulcus IOL implantation while still allowing the use of single-piece acrylic IOLs and offering the chance, in suitable eyes, for implanting a secondary IOL in the anatomical space of the capsular bag.