Evaluating the evidence for and against the use of IOLs in infants and young children

Kumar, Priyanka; Lambert, Scott R.

doi:10.1586/17434440.2016.1153967

Cited by 25 publications

(14 citation statements)

References 46 publications

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“…Recurrent visual axis opacification (18%) was the most common adverse event in the TAPS and resulted in a number of additional intraoperative surgeries as reported in prior studies. 14,16,17,19,23,24 This is consistent with the other single-surgeon series in the literature suggesting that the rate of AEs in children between 7 and 24 months of age may approach that of children 2 to 16 years of age. 1,18,19,21 Corectopia was documented less frequently in the pseudophakic patients in this series than in the younger children of the IATS (2% vs. 28%).…”

Section: Intraoperative Complications and Adverse Eventssupporting

confidence: 84%

Outcomes of Unilateral Cataracts in Infants and Toddlers 7 to 24 Months of Age

et al. 2019

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Purpose: To evaluate outcomes of unilateral cataract surgery in children 7 to 24 months of age. Design: Retrospective case series at 10 Infant Aphakia Treatment Study (IATS) sites. Participants: The Toddler Aphakia and Pseudophakia Study is a registry of children treated by surgeons who participated in the IATS.Methods: Children underwent unilateral cataract surgery with or without intraocular lens (IOL) placement during the IATS enrollment years of 2004 and 2010.Main Outcome Measures: Intraoperative complications, adverse events (AEs), visual acuity, and strabismus.Results: Fifty-six children were included with a mean postoperative follow-up of 47.6 months. Median age at cataract surgery was 13.9 months (range, 7.2e22.9). Ninety-two percent received a primary IOL. Intraoperative complications occurred in 4 patients (7%). At 5 years of age, visual acuity of treated eyes was very good (20/40) in 11% and poor (20/200) in 44%. Adverse events were identified in 24%, with a 4% incidence of glaucoma suspect. An additional unplanned intraocular surgery occurred in 14% of children. Neither AEs nor intraocular reoperations were more common for children with surgery at 7 to 12 months of age than for those who underwent surgery at 13 to 24 months of age (AE rate, 21% vs. 25% [P ¼ 0.60]; reoperation rate, 13% vs. 16% [P ¼ 1.00]).Conclusions: Although most children underwent IOL implantation concurrent with unilateral cataract removal, the incidence of complications, reoperations, and glaucoma was low when surgery was performed between 7 and 24 months of age and compared favorably with same-site IATS data for infants undergoing surgery before 7 months of age. Our study showed that IOL implantation is relatively safe in children older than 6 months and younger than 2 years.

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Section: Intraoperative Complications and Adverse Eventssupporting

confidence: 84%

Outcomes of Unilateral Cataracts in Infants and Toddlers 7 to 24 Months of Age

et al. 2019

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“…18e20,29 Visual axis opacification (VAO) is a common AE after cataract surgery in infants and children. 5,8,12,13,19,28,29 Because the implanted IOL's presence and volume in the capsular bag limits the formation of a closed Soemmerring ring, VAO occurs more commonly in pseudophakic eyes. In the present cohort for which IOL insertion was at surgeon discretion, VAO was more common in first operated eyes that received primary IOLs (32%) versus those that did not (8%).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Bilateral Cataracts Removed in Infants 1 to 7 Months of Age Using the Toddler Aphakia and Pseudophakia Treatment Study Registry

et al. 2020

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To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes.Design: Retrospective case series review at 10 IATS sites.Participants: The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS.Methods: Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010.Main Outcome Measures: Visual acuity (VA), strabismus, adverse events (AEs), and reoperations.Results: One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1e7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00e1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (<20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (<9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P ¼ 0.037; and smaller cornea: OR, 3.95; P ¼ 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P ¼ 0.023; and smaller cornea: OR, 4.78; P ¼ 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P ¼ 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%).Conclusions: Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea. Ophthalmology 2020;127:501-510 ª 2019 by the American Academy of Ophthalmology Supplemental material available at www.aaojournal.org. MethodsThis study was approved by the institutional review board or ethics review board at all participating institutions (Mayo Clinic,

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“…Most surgeons recommend deferring primary IOL implantation in infants below 3 months in unilateral cataracts and <7 months in bilateral cases. [ 1 ] On the contrary, the Infant Aphakia Treatment Study (IATS) showed that at 4.5-year follow-up, visual outcomes were similar in pseudophakic and aphakic infants treated with contact lenses (CLs). [ 2 ] In addition, pseudophakic children had a greater risk of visual axis opacification (VAO) and additional intraocular surgery.…”

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confidence: 99%

Long-term outcomes following primary intraocular lens implantation in infants younger than 6 months

Negalur

Sachdeva

Neriyanuri

et al. 2018

Indian J Ophthalmol

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Purpose:To study the long-term safety profile and visual outcomes of primary intraocular lens (IOL) implantation in infants <6 months of age.Methods:This was a retrospective observational study conducted at a tertiary eye care center in South India. Infants under 6 months meeting the selection criteria who underwent cataract surgery (lens aspiration, primary posterior capsulorhexis, and anterior vitrectomy) with primary IOL implantation between January 2008 and December 2011 and minimum 3-year follow-up were included. Patient demographics, serial refractions, visual acuity, complications, and associated amblyopia/strabismus were reviewed. Visual acuity, myopic shift, and complications were the outcome measures.Results:Sixty-nine eyes of 38 infants (31 bilateral; mean age: 4.6 months) were reviewed. Mean follow-up was 51 months (range: 36–84). Median logMAR best-corrected visual acuity at the final visit was 0.74 (interquartile range [IQR]: 0.50–0.98) in eyes with bilateral cataracts and 0.87 (IQR: 0.60–1.14) in eyes with unilateral cataracts with an average myopic shift of 6.7 diopters over 4.2 years. Most common postoperative complication was visual axis opacification (VAO) (13 eyes, 18%), necessitating membranectomy followed by pigmentary IOL deposits (11 eyes, 15%), and IOL decentration and glaucoma in four eyes each (5.6%). Mixed linear effect model found no significant association of age, gender, laterality, and postoperative complications with final visual acuity (P ≥ 0.05). Eyes with unilateral cataracts had a greater myopic shift than bilateral cases (P = 0.03).Conclusion:Primary IOL implantation in infants <6 months is reasonably safe in appropriately selected infants. VAO was the most common postoperative complication, and a large myopic shift was observed.

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Evaluating the evidence for and against the use of IOLs in infants and young children

Cited by 25 publications

References 46 publications

Outcomes of Unilateral Cataracts in Infants and Toddlers 7 to 24 Months of Age

Outcomes of Unilateral Cataracts in Infants and Toddlers 7 to 24 Months of Age

Outcomes of Bilateral Cataracts Removed in Infants 1 to 7 Months of Age Using the Toddler Aphakia and Pseudophakia Treatment Study Registry

Long-term outcomes following primary intraocular lens implantation in infants younger than 6 months

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