Visual outcomes and complications of cataract surgery with primary implantation in infants

Abstract

To describe the visual results and postoperative complications of cataract surgery with primary intraocular lens (IOL) implantation performed in infants and to determine possible predictive factors related to poor visual outcome. A retrospective consecutive case series of cataract surgeries with primary IOL implantation in infants was performed. Visual outcome and postoperative complications were recorded. A final visual acuity>0.5 logMAR was considered as a poor visual outcome. Sixty-one consecutive procedures were evaluated in 43infants. Eighteen infants (42%) had bilateral cataract surgery and 25(58%) had monocular surgery. The median age at primary surgery was 5.7months (range: 4weeks-24months). The median follow-up was 47months (range: 14-60months). The median best-corrected visual acuity in logarithm of the minimum angle of resolution (logMAR) at the last follow-up examination was 1.00 in the case of unilateral surgery and 0.40 in the case of bilateral surgery. The overall visual result in all eyes was 0.50logMAR. A better visual result was achieved when the infants were younger than 6months or older than 12months of age when surgery was performed. Opacification in the visual axis requiring secondary surgery occurred in 54% of the eyes (33/61). Postoperative inflammation occurred in 41% of the eyes (25/61) but was not associated with poor visual outcome (P=0.39). Glaucoma affected 11.5% of the eyes (7/61) and was significantly associated with poorer visual function (OR: 15.36, 95% CI 1.02-230.35, P=0.05). Compared with the unilateral cataract group, the OR of poor visual acuity was 0.06 (95% CI 0.01-0.35, P<0.01) in the bilateral cataract group. No statistical association was observed between final visual acuity>0.5 logMAR and leukocoria at time of diagnosis, IOL-related complications and postoperative strabismus. Primary IOL implantation is associated with an overall satisfactory visual outcome, especially when surgery is performed before 6months or after 12months of age and in bilateral cases. Glaucoma is the main complication associated with poor visual outcome.