Objective To evaluate the characteristics of strabismus in infants who underwent cataract surgery with and without intraocular lens (IOL) implantation. Design Secondary outcome analysis in a prospective, randomized clinical trial Participants The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter (n = 12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract. Intervention Infants underwent cataract surgery with or without placement of an IOL. Main Outcome Measures The proportion of patients who developed strabismus during the first 12 months of follow-up was calculated using the life-table method, and compared across treatment groups and age strata using a log-rank test. Results Strabismus developed within the first 12 months of follow-up in 38 (life table estimate: 66.7%) pseudophakic infants and 42 (life table estimate: 74.5%) infants treated with contact lenses (p=0.59). The younger cohort (< 49 days) at the time of surgery developed less strabismus (29 of 50, life table estimate: 58.0%) than the older cohort (≥ 49 days) (51 of 64, life table estimate: 80.0%) (p<0.01). Conclusions Intraocular lens placement does not prevent the early development of strabismus following congenital cataract surgery. However, strabismus was less likely to develop in infants whose cataract was removed at an earlier age.

Purpose To evaluate sensorimotor outcomes among children in the Infant Aphakia Treatment Study (IATS). Methods Secondary outcome analysis was performed in this randomized, multicenter, clinical trial comparing treatment of unilateral aphakia with a primary intraocular lens (IOL) or contact lens (CL) correction. The alignment characteristics and sensory status of children through age 5 years were evaluated. Results In the IATS study, 91 of 112 children (81%) developed strabismus through age 5 years. Of 34 infants who were orthotropic at near 12 months after cataract surgery, by age 5 years 14 (41%) were orthotropic at distance, and 15 (44%) were orthotropic at near at age 5 years without strabismus surgery. Eight of 56 children (14%) in the CL group and 13 of 56 (23%) in the IOL group were orthotropic at distance (P = 0.33) by 5 years of age and had no history of strabismus surgery. Thirteen of 48 (27%) who underwent cataract surgery prior to 49 days of age compared to 8 of 64 (13%) who had surgery after 49 days were orthotropic (P = 0.085). Median visual acuity in the operative eye was 0.4 logMAR (20/50) for children with orthotropia or microtropia (<10Δ) versus 1.10 logMAR (20/252) for strabismus ≥10Δ (P = 0.0001). Stereopsis was detected in 12 of 21 children (57%) with orthotropia versus 16 of 89 (18%) children with strabismus (P = 0.0006). Conclusions IOL placement does not reduce the development of strabismus after monocular congenital cataract surgery. Improved ocular alignment by age 5 years correlated strongly with improved visual acuity and stereopsis.

Purpose-To report strabismus surgery frequency and outcomes after monocular infantile cataract surgery with or without IOL implantation. Methods-TheInfant Aphakia Treatment Study (IATS) is a randomized, multicenter clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract. This report is a secondary outcome analysis of ocular motor data from IATS patients who underwent strabismus surgery prior to age 5 years.Correspondence: Erick Bothun, MD, Mayo Clinic, Department of Ophthalmology, 200 First Street SW, Rochester, Minnesota 55905 (bothun.erick@mayo.edu). * A full listing of study investigators appears in eSupplement 1, available at jaapos.org.This data used in this study was presented as a poster at the Annual Meeting of the American Academy of Ophthalmology, November 14-15, 2015.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-In this study cohort, cataract surgery performed in the first 6 weeks of life was associated with a reduced frequency of strabismus surgery. Strabismus surgery outcomes in this population are guarded. Surgical improvement of strabismus does not appear to influence longterm visual acuity. HHS Public AccessAlthough strabismus is a common in infants with unilateral congenital cataract, with a reported frequency ranging from 27% to 100%, 1-10 there are few reports, and no prospective studies, on strabismus surgery outcomes in this population. 9,11,12 In the prospective Infant Aphakia Treatment Study (IATS), strabismus was detected in 81% of infants by age 5. 13 The present study evaluates the pre-and postoperative characteristics of children who underwent strabismus surgery up to 5 years postoperatively. Subjects and MethodsThe Infant Aphakia Treatment Study (IATS) is a randomized, multicenter, longitudinal study that evaluated the clinical outcomes of 2 treatments (contact lens [CL] vs intraocular lens [IOL]) for aphakia after early surgery for unilateral infantile cataract. 14 The randomization was stratified according to the category of the age of the infant at surgery (28-48 vs 49-210 days). The primary outcomes at 5 years of age, including visual acuity, adverse events, and strabismus have been previously described. [13][14][15]16 The IATS was approved by the institutional review boards of all the participating institutions and complied with the US Health Insurance Portability and Accountability Act of 1996. The off-label research use of the AcrySof SN60AT and MA60AC IOLs (Alcon Laboratories, Fort Worth, TX) was covered by US Food and Drug Administration...

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