Aphakic Group Research Articles

Volume measurement of the vitrectomised eye and its applications in practice.

To estimate the vitreous cavity replacement volume after pars plana vitrectomy and analyze its correlation with axial length and refractive error. Observational cross-sectional study on 103 eyes undergoing vitrectomy. Fluid-air exchange was performed using a soft-tip cannula connected to a PVC tubing, the distal end of which opened into a 10-cc syringe without the plunger. The collected fluid was measured (and correction factors applied) to estimate the vitreous cavity volume. The mean axial length of 103 eyes was 23.43 ± 1.54 mm. The mean vitreous cavity volume was 4.46 ± 0.83 mL (2.8-8.1 mL). There was a strong positive correlation between axial length and vitreous volume, which was stronger for pseudophakic and aphakic groups than for phakic groups. Accurate assessment of vitreous cavity volume can enable precise quantification of tamponade, intravitreal drugs, and intravitreal chemotherapeutic agents. This will allow better surgical outcomes, decreased toxicity, and increased cost-effectiveness due to lesser wastage. To estimate the vitreous cavity replacement volume after pars plana vitrectomy and analyze its correlation with axial length and refractive error.

Ectopia Lentis: Clinical profiles in a large cohort of children from a Tertiary Eye Care network in India.

To study the clinical presentations, visual, and refractive profiles of children with congenital ectopia lentis in a large cohort of patients from a tertiary eye care network in India. A retrospective review of electronic medical records from December 2012 to December 2020 was conducted. Two hundred and ninety-seven consecutive children ≤18 years of age at presentation were identified and analyzed for demographic details, patient distribution, lens subluxation, visual, and refractive profiles before and after the interventions. Five hundred and ninety-four eyes of 297 (male 56%; n = 166) patients were analyzed. The mean age at presentation was 8.74 ± 3.89. Best-corrected visual acuity (BCVA) at presentation ranged from 0.3 logMAR to 3.5 logMAR; (Snellen: 6/9 - close to face [CF]) (mean 0.89 ± 0.68). High myopia (n = 201; 33.83%) and mild astigmatism (n = 340; 57.23%) were more frequent. Temporal (n = 108; 18.18%) subluxation was most common followed by superior. Lensectomy with limited vitrectomy was performed in 243 eyes of 127 patients (40.90%). Median preoperative BCVA was 1.0 (range: 0.3-3.5 logMAR; 20/40 - CF). Median postoperative BCVA was 0.5 logMAR (6/18) in the pseudophakic group and 0.6 logMAR (6/24) in the aphakic group. Spherical equivalent in myopic children reduced from -12.06 ± 6.84D to -1.57D (-0.25D to - 5.5D) in the pseudophakic group and +9.3D (+5.5D to 15.5D) in the aphakic group. This study is a large cohort of children presenting with ectopia lentis. Following intervention, an improvement in the median BCVA and refractive correction was noted in the entire cohort.

Long-term surgical outcomes of pediatric cataract—multivariate analysis of prognostic factors

We assessed the 10-year postoperative outcomes of pediatric cataract patients who underwent surgery at the age of 6 years or younger. A retrospective review of medical charts was conducted for 457 eyes of 277 patients, with the age at surgery averaging 1.3 ± 1.5 years (mean ± SD) and the follow-up duration averaging 12.8 ± 2.4 years (ranging from 10 to 17 years). The cohort included 250 eyes of 125 cases with bilateral aphakia (age at surgery 0.5 ± 0.8 years), 110 eyes of 55 cases with bilateral pseudophakia (1.9 ± 1.6 years), 42 cases with unilateral aphakia (1.1 ± 1.3 years), and 55 cases with unilateral pseudophakia (2.6 ± 1.7). A forward stepwise multiple regression analysis revealed that the best-corrected visual acuity at the final visit was significantly associated with laterality of cataract (with bilateral cases showing better results compared to unilateral cases), presence of systemic comorbidities, presence of ocular comorbidities, development of glaucoma, and phakic status (with better results in the pseudophakia group than the aphakia group). The age at surgery did not significantly affect visual acuity outcomes. A multiple logistic regression analysis demonstrated that the incidence of secondary glaucoma was significantly linked to younger age at surgery, phakic status (higher in aphakic than pseudophakic eyes), and presence of systemic comorbidities. In conclusion, after pediatric cataract surgery, final visual acuity was better in patients with bilateral cataracts, those treated with an intraocular lens, and cases without systemic or ocular comorbidities and secondary glaucoma. The development of secondary glaucoma was linked to younger age at surgery, aphakic status, and presence of systemic comorbidities.

Risk of visual axis opacification in infants with and without primary IOL implantation after congenital cataract surgery performed during the first 4 months of age

PurposeThe study evaluates the rate of postoperative formation of a pupillary membrane (PM) and posterior visual axis opacification (PVAO) in infants with and without primary IOL implantation during the first 4 months of infancy.MethodsMedical records for 144 eyes (101 infants) operated between 2005 and 2014 were evaluated. A posterior capsulectomy and anterior vitrectomy were performed. Primary IOL implantation was performed in 68 eyes, while 76 eyes were left aphakic. There were 16 bilateral cases in the pseudophakic group and 27 in the aphakic group. The follow-up period was 54.3 ± 21.05 months and 49.1 ± 18.60 months, respectively. Fisher’s exact test was used for statistical analysis. The two-sample t-test with equal variance was used to compare surgery age, follow-up period and time intervals of complications.ResultsThe mean age of surgery was 2.1 ± 0.85 months in the pseudophakic and 2.2 ± 1.01 months in the aphakic group. PM was diagnosed in 40% pseudophakic and 7% aphakic eyes. A second surgery for PVAO was performed in 72% pseudophakic and 16% aphakic eyes. Both were significantly higher in the pseudophakic group. In the pseudophakic group, the number of PVAO was significantly higher in infants operated before 8 weeks of age compared to surgery age 9–16 weeks. The frequency of PM was not age-dependent.ConclusionAlthough it remains feasible to implant an IOL during the primary surgery, even in very young infants, there should always be solid arguments for this decision since it puts the child at higher risk of repeated surgeries under general anaesthesia.

Comparison of Changes in Endothelial Corneal Cell Count of Vitrectomized Silicone Oil-Filled Eyes

Objective: To determine the mean endothelial cell change in patients undergoing vitrectomy with silicon oil replacement and to compare the corneal endothelial cell loss frequency of phakic, pseudophakic, and aphakic Vitrectomized Silicone Oil-filled eyes.
 Study Design: Cross-sectional Study.
 Place and Duration of Study: Retina Department, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan, from Aug 2020 to Jan 2021.
 Methodology: A total of one hundred patients of either gender, aged 50-80 years, who underwent vitrectomy with silicon oil replacement were enrolled in the study. Patients were assigned to one of the three groups based on their lens status, phakic,pseudophakic and aphakic. Mean endothelial count density before and three months after vitrectomy was estimated in all the patients.
 Results: Cell loss was higher in the pseudophakic and aphakic groups than in the phakic groups. More than 5% cell loss at three months was observed in 11.8%, 21.2% and 33.3% in the phakic, pseudophakic, and aphakic groups, respectively (p-value 0.102).
 Conclusions: Mean endothelial cell loss was higher in the pseudophakic and aphakic groups than in the phakic groups.

Incidence of and risk factors for suspected and definitive glaucoma after bilateral congenital cataract surgery: a 5-year follow-up

AimsTo report the incidence and associated risk factors for developing suspected and definitive glaucoma after bilateral congenital cataract (CC) removal with a 5-year follow-up.MethodsSecondary analysis of a prospective longitudinal cohort...

Surgical interventions for bilateral congenital cataract in children aged two years and under.

Surgical interventions for bilateral congenital cataract in children aged two years and under.

Management of paediatric ectopia lentis at an Indonesian referral hospital: A retrospective review

Background: Ectopia lentis in children is rare and often associated with systemic conditions. Left untreated, it can lead to visually debilitating complications. Although there are various techniques available, no current consensus for treatment of paediatric ectopia lentis exists.Aim: To describe the management and visual outcomes of paediatric ectopia lentis in an academic referral hospital.Setting: This study was conducted at Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia.Methods: A retrospective review was conducted on the medical records of all paediatric ectopia lentis patients treated at our hospital, from 2011 to 2020. Primary outcomes include uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), treatment, surgical technique, selection of intraocular lens (IOL), and postoperative complications.Results: This study included 66 eyes of 39 patients. Average age at initial presentation was 7.8 (2–17) years. Aetiology was mostly non-traumatic, whilst four were secondary to trauma. All eyes except one underwent surgery, and IOLs were inserted in 57.4% of the non-traumatic cohort, with iris-claw IOL as the most popular choice (85.7%). Uncorrected visual acuity and BCVA significantly improved in pseudophakic and aphakic groups (p 0.05). Nearly 60% achieved a BCVA of 6/12 or greater, and the proportion was higher amongst pseudophakic group. Ten eyes had post-operative complications, with a median onset of 393 (1–1095) days after surgery.Conclusion: With varied techniques used to manage paediatric ectopia lentis, the choice of technique was dependent on individual patient condition and surgeon preference. Whilst the proportion of eyes with BCVA of ≥ 6/12 was higher amongst the pseudophakic eyes than aphakic eyes, IOL implantation entails the risk of complications, whereas no complications occurred in those left aphakic. Therefore, no particular technique can be considered marginally superior to the other, and larger studies are needed.

Outcomes of surgical intervention in cases of ectopia lentis.

Purpose:To evaluate the outcomes of surgical intervention in cases of ectopia lentis.Methods: This retrospective study included all cases of ectopia lentis that presented between June 2015 and March 2019 in a tertiary care center. They were reviewed retrospectively. The corrected distance visual acuity (CDVA), severity of lens subluxation, type of surgery, intra-operative and post-operative complication, and specular count were recorded.Results: Seventy-eight eyes of 57 cases with a mean age at surgery of 14.73 years were analyzed. Intra-lenticular lens aspiration was the most common (n-62/78; 79.5%) surgical procedure followed by lens aspiration, intra-capsular cataract extraction, phaco-aspiration, and pars-plana lensectomy. Simultaneous intra-ocular lens (IOL) implantation was performed in 46.2% (n-32/78) of the eyes. The mean CDVA improved from 0.85 ± 0.55 logMAR to 0.44 ± 0.29 logMAR at 6 weeks follow-up. The post-operative CDVA was significantly better in the pseudo-phakic group compared to the aphakic group (p-0.02). The patient’s age at the time of surgery and the degree of subluxation did not impact the final visual outcome. Intra-operative complication included vitreous hemorrhage (n-1) and lens matter drop (n-1). Post-operative complications were noted in 26.9% of the eyes (n-21/78) with a higher complication rate in the pseudo-phakic group (p-0.00). A second intervention was required in 7.7% of the eyes (n-6/78).Conclusion: Age and degree of subluxation at the time of surgery do not influence the final visual outcome in cases of ectopia lentis undergoing lens extraction surgery. IOL implantation results in better visual outcomes but is associated with a high complication rate.

Visual and refractive outcomes following secondary intraocular lens implantation

ABSTRACT Purpose To analyze the visual and refractive results after secondary IOL implantation using different surgical techniques - iris-claw aphakic IOL through a corneal incision or scleral tunnel, and 3-piece IOL into the ciliary sulcus. Patients and methods Retrospective study including patients that were submitted to secondary IOL implantation from January 2017 to December 2019 at the Department of Ophthalmology of Hospital de Braga, Portugal. We collected demographic data (age, surgical indication, comorbidities, surgical technique, IOL implanted, and intra and postoperative complications) and visual and refractive data [preoperative and 3-month, 6-month, and 12-month postoperative corrected-distance visual acuity (CDVA), spherical equivalent (SE), manifest cylinder, and intraocular pressure]. Results 128 eyes from 123 patients were included. The most frequent surgical indications were IOL subluxation/luxation (62.5%) and intraoperative posterior capsular rupture (23.4%). CDVA improved from 1.26 ± 0.51 to 0.47 ± 0.49 logMar (p < .001). CDVA was significantly better in the 3-piece into the ciliary sulcus IOL group than both other groups. The final SE was −0.68 ± 0.94 diopters. The mean manifest refractive cylinder remained stable until the 6th month after the surgery (p = .454) and improved in the last 6 months of follow-up (p = .015). In the postoperative period, the cylinder was higher in the corneal incision iris-claw aphakic IOL group and lower in the 3-piece IOL into the ciliary sulcus group (p < 0,05). The corneal incision iris-claw aphakic IOL group presented the most postoperative complications. Conclusion All techniques showed satisfying results. The 3-piece IOL into the ciliary sulcus group showed the best visual and refractive performance, followed by the scleral tunnel iris-claw IOL group and the corneal incision iris-claw IOL group.

A GEE model for predicting axial length after cataract surgery in children younger than 2years of age.

To develop a model for predicting postoperative axial length (AL) in children undergoing cataract surgery younger than 2years of age. The Eye Hospital of Wenzhou Medical University, Hangzhou, China DESIGN: Retrospective study. Children were included only if AL data were available before surgery and at least 1year after surgery. Eyes were divided into pseudophakic, aphakic, and unaffected eye groups. Variables that could influence axial growth were analyzed and a multivariable generalized estimating equation regression model was developed to predict postoperative AL. 333 eyes from 190 patients were included. We observed a logarithmic linear correlation between age and AL in the unaffected eye group, AL = (2.7924 × log of age in months) + 17.607, R2 = 0.6596. Meanwhile, The GEE model of eyes with cataracts can be written as follows: Postoperative AL = 6.408 + 0.611 × (baseline AL) + 0.007 × (baseline age) - -0.006 (baseline age) × (age at follow-up) - -0.391 × coefficient of surgery. The ages were recorded in months, the ALs were recorded in millimeter. The assessment of AL is one of the most important parts of successful postoperative management in congenital cataract patients. This study established an AL estimate formula for children aged ≤ 2years with congenital cataract who underwent cataract surgery. This model theoretically could be used to predict individual future AL for child undergoing cataract surgery.

Advisability of primary intraocular lens implantation for infants under 2: A systematic review and meta-analysis.

The present meta-analysis compared the postoperative visual performance of primary intraocular lens (IOL) implantation and primary aphakia in cataract infants. PubMed, Embase, Science Direct and Cochrane Library were searched, and postoperative visual acuity (VA) and complications were extracted and pooled. Three randomised controlled trails (RCTs) and five retrospective studies were included. The postoperative VA of children younger than 4.5years in primary IOL group was better than that in primary aphakia group [MD=-0.14, 95% CI: (-0.23, -0.06), P=.90]. The subgroup analysis based on RCTs and on unilateral cataract surgery revealed the same result. There was no significant difference in the incidence of glaucoma, strabismus, retinal detachment and nystagmus between primary IOL group and primary aphakia group [OR=1.02, 95% CI: (0.62, 1.68), P=.48 for glaucoma; OR=0.76, 95% CI: (0.30, 1.90), P=.05 for strabismus; OR=0.49, 95% CI: (0.07, 3.30), P=.34 for retinal detachment; OR=1.26, 95% CI: (0.68, 2.36), P=.92 for nystagmus]. The proportion of patients requiring postoperative visual axis opacification (VAO) clearing was higher in primary IOL group than that in primary aphakia group [OR=9.22, 95% CI: (4.74, 17.96), P=.16]. For infants under 2years of age, primary IOL implantation would provide more visual benefits compared with primary aphakia did, though the benefits would taper off with the age reaching 4.5years. Moreover, the current study revealed a higher VAO incidence r in primary IOL implantation group.

İris Arkasına İntraoküler Lens İmplantasyonu Uzun Dönem Sonuçlarımız ve Diğer Gözle Karşılaştırılması

Objective: To evaluate the long-term results of primary and secondary posterior iris-claw intraocular lens (IOL) implantation and a comparative analysis with the fellow eye Material and Methods: One hundred-one eye of 99 patients who underwent iris-claw IOL implantation were included in this retrospective study. Data recorded for each subject consisted of preoperative and postoperative spherical equivalent (SE), best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell count (ECC) values, and biomicroscopic findings. Patients were divided into two main groups according to primary (complicated cases) and secondary (aphakic cases) implantation. The comparison of the groups was made in terms of SE, BCVA, IOP, CCT, and ECC values. Also, postoperative CCT and ECC comparison was made between the fellow eye and irisclaw IOL implanted eyes. Results: Median duration of follow-up was 44.6 (range 1-83) months. While postoperative SE, IOP, CCT values were similar in two groups (p=0.754, p=0.621, p=0.520, respectively), postoperative BCVA and ECC values were statistically higher in the aphakic group than the complicated group (p=0.048, p=0.004, respectively). ECC values in iris-claw IOL-implanted eyes were lower than the same patients' fellow phakic eyes (p=0.003), but there was no statistically significant difference between iris-claw IOL-implanted eyes and the fellow pseudophakic eyes for ECC values (p=0.520). Conclusion: Although retropupillary iris-claw IOL fixation with scleral tunnel might be challenging, it is a safe and effective method with better visual and refractive outcomes.

Investigation of intraocular pressure of the anterior chamber and vitreous cavity of porcine eyes via a novel method

To evaluate a new method of measuring the intraocular pressure (IOP) in the vitreous cavity. IOPs in the anterior chamber and vitreous cavities of 24 porcine eyes (12 eyes with lenses and 12 eyes without lenses) were measured directly, continuously, and simultaneously. We used a needle as a part of the pressure sensor to measure the anterior chamber IOP and a disk-shaped sensor to measure the vitreous cavity IOP. A significant group-by-condition interaction on the vitreous cavity IOP between the two groups (phakia and aphakia) and four conditions of anterior chamber IOP were observed (F[3,258] = 5.8564, p < 0.001). A positive correlation was observed between the vitreous cavity IOP and anterior chamber IOP in both the phakia group (R = 0.96, p < 0.001) and the aphakia group (R = 0.97, p < 0.001). No significant correlation was observed between the ΔIOPv-a (vitreous cavity IOP − anterior chamber IOP) and anterior chamber IOP in either group (phakia group: R = − 0.18, p = 0.034; aphakia group: R = − 0.029, p = 0.73). The vitreous cavity IOP measured with the new sensor was well-correlated with the anterior chamber IOP in the physiological range tested.

Incidence of posterior vitreous detachment after congenital cataract surgery: an ultrasound evaluation.

To investigate the incidence of developing posterior vitreous detachment (PVD) in children after congenital cataract surgery. This is a prospective study which recruited 131 children with congenital cataracts who underwent cataract surgery between June 1, 2015, and September 1, 2018. The patients were divided into two groups depending on their post-operation phakic status (with or without IOL implantation). Infants aged from 6 to 12 months from two groups were analyzed as subgroups, respectively. B-scan ultrasonography was performed before the procedure and at 1, 3, 6, 9, and 12-month follow-ups, respectively, after the operation. Of the 131 eyes included in the analyses, 74 were aphakic, and 57 were pseudophakic after surgery. The postoperative rate of PVD in all analyzed eyes was 6.9% (9 of 131 eyes). After 12 months, PVD was significantly more prevalent in the eyes that underwent cataract surgery with IOL implantation (10.5%, 6 of 57 eyes) compared to the eyes without IOL implantation (4.1%, 1 of 74 eyes, P < 0.05); however, the eyes in the aphakic group were significantly younger than the eyes in the pseudophakic group, while the mean axial length (AL) of the pseudophakic eyes (21.11 ± 2.07 mm) was significantly higher than that of the aphakic eyes (18.93 ± 1.86 mm) (P < 0.01). In patients between the ages of 6 and 12 months of age from the two groups, the AL of patients with IOL implantation continued to be significantly increased compared to the group without IOL implantation (20.44 ± 1.68 mm vs. 19.78 ± 1.52 mm, P < 0.01). At the follow-up appointments, two patients with PVD were observed among the 14 eyes that had undergone cataract surgery with IOL implantation, while one eye was observed to have developed PVD among the 15 eyes without IOL implantation. PVD occurs with greater frequency after congenital cataract surgery, particularly in eyes that have undergone IOL implantation. We suggest that PVD should be carefully monitored in children after congenital cataract surgery to avoid subsequent ocular pathologies such as retinal detachment. Future studies are needed to determine other potential risk factors that have not been as thoroughly explored, as opposed to better-known factors such as older age, longer axial length, and IOL implantation.

Outcomes of secondary intraocular lens implantation in the Infant Aphakia Treatment Study.

To report outcomes of secondary intraocular lens (IOL) implantation in the Infant Aphakia Treatment Study (IATS). Multicenter clinical practice. Secondary analysis of patients enrolled in a randomized clinical trial. Details regarding all secondary IOL surgeries conducted in children enrolled in the IATS were compiled. Visual outcomes, refractive outcomes, and adverse events at the age of 10½ years were evaluated. Comparisons were made with eyes that remained aphakic and with eyes randomized to primary IOL placement. The study included 114 infants, 57 in the aphakic group and 57 in the primary IOL group; 55 of 57 patients randomized to aphakia with contact lens correction were seen for the 10½-year study visit; 24 (44%) of 55 eyes had secondary IOL surgery. Median age at IOL surgery was 5.4 years (range 1.7 to 10.3 years). Mean absolute prediction error was 1.00 ± 0.70 diopters (D). At age 10½ years, the median logarithm of the minimum angle of resolution visual acuity (VA) was 0.9 (range 0.2 to 1.7), similar to VA in the 31 eyes still aphakic (0.8, range 0.1 to 2.9); the number of eyes with stable or improved VA scores between the 4½-year and 10½-year study visits was also similar (78% secondary IOL eyes; 84% aphakic eyes). For eyes undergoing IOL implantation after the 4½-year study visit (n = 22), the mean refraction at age 10½ years was -3.20 ± 2.70 D (range -9.90 to 1.10 D), compared with -5.50 ± 6.60 D (n = 53, range -26.50 to 3.00 D) in eyes with primary IOL (P = .03). Delayed IOL implantation allows a more predictable refractive outcome at age 10½ years, although the range of refractive error is still large.

Grating Visual Acuity in phakic, aphakic, and pseudophakic Poodles.

To compare the grating visual acuity (VA) measured by visual evoked potentials (VEP) in phakic, aphakic, and pseudophakic Poodles. Thirty-six Poodle dogs aged from 4 to 14years. Animals were allocated into three different groups according to their lens status: phakic group (n=12), aphakic group (n=12), and pseudophakic group (n=12). Grating VA was measured in cycles/degree (cpd) in all animals using the electrodiagnosis system Roland RETIport® in a dark room without using any mydriatic, sedative, or anesthetic drugs. The mean grating VA in the phakic, aphakic, and pseudophakic groups was 5.9±1.0cpd (20/102-Snellen equivalent), 2.6±0.7cpd (20/231), and 5.2±1.1cpd (20/116), respectively. The VA from aphakic eyes was significantly lower when compared to the phakic and pseudophakic eyes (P<.05). There was no significant difference in VA between phakic and pseudophakic eyes. The VEP is a useful tool for the evaluation of grating visual acuity in canines. The study showed that IOL implantation following phacoemulsification results in improved VA as measured by VEP compared to that of the aphakic eye and resulted in VA that was similar to that of the normal eye.

Refractive and Visual Outcomes after Scleral Fixated Intraocular Lens Implantation in Children with Ectopia Lentis

This study was conducted to report the refractive and visual outcome after Scleral Fixated Intraocular Lens (SFIOL) implantation in children with nontraumatic ectopia lentis. Retrospective review of the medical records of 25 eyes of 15 patients who underwent SFIOL implantation in children with non-traumatic ectopia lentis. The mean best corrected visual acuity (BCVA) before SFIOL implantation was 1.07 ± 0.9 logMar units [median: 0.9, Interquartile range (ΙQR): 0.415 to 1.555] which improved to 0.41 ± 0.33 logMar units (median: 0.22, ΙQR: 0.180 to 1.555) at two months postoperative follow up. In phakic group, the mean spherical refraction preoperatively was -12.04 ± 7.82 DS (dioptre sphere) (IQR: +16 to -5.875) and postoperatively was +0.93 ± 2.67DS (IQR: -0.375 to +2). In aphakic group, the mean spherical refraction preoperatively was +12.22 ± 2.05 DS and postoperatively was +1.2 ± 1.9 DS. The mean total astigmatism preoperatively was -6.44 ± 4.95 DC (dioptre cylinder) (median: 6, IQR: -10.50 to +2) and postoperatively was -1.47 ± 0.98 DC (median: -1.5, IQR: -2 to - 0.625 ). The mean IOL induced astigmatism was -1.01 ± 0.95 DC (median -0.75, IQR: -1.33 to - 0.25). The spherical refractive equivalent was within 2 Diopter (D) of the target refraction calculated preoperatively in 20 eyes and in five eyes it was more than 2 D. SFIOL implantation is associated with good visual outcome with a significant improvement in the refractive error. However, a longer follow up is required to assess the change of refraction and the stability of the SFIOL.

Long-term Effect of Intraocular Lens vs Contact Lens Correction on Visual Acuity After Cataract Surgery During Infancy

Although intraocular lenses (IOLs) are often implanted in children, little is known whether primary IOL implantation or aphakia and contact lens correction results in better long-term visual outcomes after unilateral cataract surgery during infancy. To compare long-term visual outcomes with contact lens vs IOL correction following unilateral cataract surgery during infancy. This multicenter randomized clinical trial enrolled 114 infants with a unilateral congenital cataract who underwent cataract surgery with or without primary IOL implantation between 1 and 6 months of age. Data on long-term visual outcomes were collected when the children were age 10.5 years (July 14, 2015, to July 12, 2019) and analyzed from March 30 through August 6, 2019. Intraocular lens implantation at the time of cataract surgery. Best-corrected visual acuity using the electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) testing protocol. Analysis was performed on an intention-to-treat basis. Best-corrected visual acuity was measured at age 10.5 years for 110 of the 114 patients (96%) enrolled as infants. The participants included 58 girls (53%) and 52 boys (47%). Overall, 27 of the children (25%) had good (logMAR 0.30 [Snellen equivalent, 20/40] or better) visual acuity in the treated eye (12 [22%] in the IOL group and 15 [27%] in the aphakia group), but 50 children (44%) had a visual acuity of logMAR 1.00 (Snellen equivalent, 20/200) or worse (25 [44%] in the IOL group and 25 [44%] in the aphakia group). The median logMAR acuity in the treated eye was similar in children randomized to receive an IOL at the time of cataract extraction (0.89; interquartile range [IQR], 0.33-1.43 [Snellen equivalent, 20/159]) and those who remained aphakic (0.86; IQR, 0.30-1.46 [Snellen equivalent, 20/145]) (IQR, 0.30-1.46; P = .82). Although the overall difference in median visual acuity between the 2 groups was small, the estimate was imprecise (99% CI for the difference in medians was -0.54 to 0.47). As in previous phases of the study, visual acuity outcomes were highly variable with only 27 children (25%) achieving excellent visual acuity in their treated eye and 50 children (44%) having poor vision in the treated eye. Implanting an IOL at the time of cataract extraction was neither beneficial nor detrimental to the visual outcome. ClinicalTrials.gov Identifier: NCT00212134.

Journal Review

Journal Review