Cataract surgery and primary intraocular lens implantation in children <=2 years old in the UK and Ireland: finding of national surveys

Abstract

Primary IOL implantation in children < or =2 has been widely adopted in the UK and Ireland. There is concordance of practice with regards to surgical technique and choice of IOL model. However, there is some variation in eligibility criteria for primary IOLs: this may reflect a lack of consensus on which children are most likely to benefit. Thus, there is a need for systematic studies of the outcomes of primary IOL implantation in younger children.

Risks and outcomes associated with primary intraocular lens implantation in children under 2 years of age: the IoLunder2 cohort study

“…Active surveillance via a national clinical research network achieved a higher level of ascertainment than the statutory databases of clinical activity,15 which supports near-complete and thus unbiased ascertainment, although capture-recapture analysis was not possible as there was no suitable independent data source for analysis 19. As shown by our survey of clinical practice, undertaken prior to the study, a high degree of uniformity of clinical approach exists across the UK/Ireland,5 enabling key aspects of management to be harmonised with BCCIG prior to data collection. Obtaining reproducible, accurate quantitative visual acuity data from young children is difficult, particularly in unilateral disease, where testing of the affected eye involves occlusion of the better seeing eye.…”

“…The BCCIG, established in 1995, is a network of ophthalmologists specialising in congenital and infantile cataract, through which key national studies have been completed 5. Following a survey of paediatric cataract surgery practice to consolidate and expand membership (n=173, see online supplementary appendix 1),5 69 surgeons at 43 hospitals across the UK and 3 in the Republic of Ireland acted as the primary respondents, identifying and reporting data on children.…”

“…Following a survey of paediatric cataract surgery practice to consolidate and expand membership (n=173, see online supplementary appendix 1),5 69 surgeons at 43 hospitals across the UK and 3 in the Republic of Ireland acted as the primary respondents, identifying and reporting data on children.…”

“…Third, some argued that IoLs could reduce the risk of postoperative glaucoma, the key sight threatening complication of childhood cataract surgery. Practitioners attracted by the potential benefits of IoL implantation for infants have adopted their use with some rapidity over the past decade,5 despite an incomplete evidence base regarding risks, benefits or patient selection. There exists no robust evidence on outcomes for young children with bilateral cataract undergoing primary IoL implantation, and limited evidence on those with unilateral disease.…”

Accuracy of routine data on paediatric cataract in the UK compared to active surveillance: lessons from the IOLu2 study

“…Primary intraocular lens (IOL) implantation is the most important recent innovation in the management of early childhood cataract, and has been widely adopted for the youngest children despite unanswered questions regarding best practice, visual benefits and adverse outcomes 1. In order to answer these questions, a prospective observational study on children undergoing congenital or infantile cataract surgery in the first 2 years of life is currently underway.…”