Complications and Visual Outcomes after Secondary Intraocular Lens Implantation in Children (original) (raw)
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Visual outcomes of secondary lens implants in children with different etiologies
Academia Letters, 2022
Aim: This study investigated visual outcomes and factors that impact vision in children receiving secondary intraocular lens (IOL) implants. Methods: Children who had traumatic or congenital cataracts and underwent secondary lens implantation for aphakia at Drashti Netralaya between 2000 and 2019 were retrospectively examined. We included all the eyes with secondary implants for aphakia correction with placement either in the bag or sulcus or through scleral fixation. We obtained data from electronic medical records and analyzed using SPSS 22 through descriptive analysis, cross tabulation, and t test. Results: Our cohort consisted of 84 eyes (mean age: 7.88 ± 6.07 years). Of the 84 eyes, 24 (28.6%) and 60 (71.4%) were female and male patients, respectively, and 32 (38.1%) had traumatic cataract. We observed significant improvements in vision following lens implantation (p=0.000). Those with nontraumatic cataracts exhibited better outcomes that did the traumatic cataract group (p = 0.004). Corneal opacity caused comorbidities in the traumatic group (14/52,14.29%). Visual outcomes significantly improved in young patients and were not affected by other variables.
Results of intraocular lens implantation in paediatric aphakia
Eye, 1992
Intraocular lenses were implanted in 16 eyes of 13 patients with congenital cataract, and visual progress was plotted using a preferential-looking technique. Initial surgery was by lens aspiration with preservation of the posterior capsule, and subsequent posterior capsulotomy without anterior vitrectomy. Poly-HEMA posterior chamber lenses were used, usually as a primary pro cedure but in four cases as a secondary procedure after contact lens failure. No serious complications were encountered. Most ey es achieved a very significant visual improvement, and none were worse than preoperatively. Residual refractive error was highly unpredictable, but did not exceed 6 dioptres. The importance of rigorous occlusion therapy is stressed. With close follow-up, this procedure offers an effective and safe method for the cor rection of unilateral paediatric aphakia, and, in selected cases only, for bilateral aphakia.
Purpose to compare between intrascleral (Yamane Technique) and trans-scleral (ab externo technique) posterior chamber intraocular lens (PCIOL)implantation in cases of pediatric aphakia. Patients and methods: a prospective interventional study included 20 aphakic eyes < 18 years old with insufficient capsular support. Patients were randomly assigned into two groups; group (1) underwent sutureless intrascleral IOL implantation using Yamane technique and group (2) underwent trans-scleral IOL implantation (ab externo technique). Outcome measures included visual acuity (uncorrected UCVA& best corrected BCVA), astigmatism (corneal and IOL-induced), Keratometric readings, IOL state and any developed surgical complications. Patients were followed for at least 6 months. Results There was a statistically significant improvement in UCVA and BCVA at 6th month compared to preoperative values, without significant difference between the 2 groups. Corneal astigmatism was higher in group (2) wher...
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015
To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support. METHODS In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients .2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth \3 mm, central endothelial cell density (CECD) \2500 cells/mm 2 , uncontrolled glaucoma, or uveitis were excluded. Best-corrected visual acuity, intraocular pressure (IOP), and CECD were measured at 1, 6, and 12 months postoperatively. RESULTS A total of 25 aphakic eyes of 18 patients (mean age, 7.86 AE 3.08 years) with insufficient capsular support for a standard posterior chamber IOL were included, 18 eyes with subluxated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95 AE 0.36; for patients with subluxation, 0.7 AE 0.26. Values improved at 1 year to 0.38 AE 0.15 (P \ 0.002) and 0.3 AE 0.2 (P \ 0.0001), respectively. One year after surgery the CECD (2892.64 AE 441.79 cells/mm 2) was significantly reduced from the preoperative and 1 month postoperative values (3573.36 AE 468.9 cells/mm 2 , 3081 AE 495 cells/mm 2 ; P \ 0.0001, P \ 0.02 resp.). Two cases (8%) developed traumatic dislocation. Pupillary block occurred in 1 case (4%). CONCLUSIONS Artisan IOL implantation for pediatric aphakia achieved a good visual outcome.
Indian journal of ophthalmology, 2014
To study the long-term outcome of cataract surgery with primary intraocular lens (IOL) in children <2 years. Retrospective analysis of bilateral cases that were operated before 2 years age for congenital cataract. All underwent primary posterior capsulotomy with anterior vitrectomy and primary IOL implantation. Only those with a follow-up of at least 8 years were evaluated. Twenty-six eyes of 13 children with bilateral cataract met the inclusion criteria. Average age at surgery was 14.15 months with a mean follow-up of 102 months. Average preoperative axial length (AL) was 19.93 mm. There was a refractive shift from a mean spherical equivalent of 1.64 D at 2 weeks after surgery to -1.42 D measured at last follow-up. Twenty-four eyes out of 26 (92%) achieved final visual acuity (VA) of 6/18 or more at last follow-up with 19/26 (73%) having acuity of 6/12 or greater. Raised intraocular pressure was documented in one eye only. Average AL recorded at last follow-up was 22.21 mm. Prim...
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2001
The method of correcting aphakia after unilateral cataract extraction during infancy is controversial. Some authorities advocate correction with an intraocular lens (IOL) whereas others advocate correction with a contact lens (CL). We compared grating visual acuity, alignment, and reoperative outcomes in age-matched children treated with these 2 modalities at 5 clinical centers. Methods: Twenty-five infants born in 1997 or 1998 with a dense unilateral congenital cataract who had cataract surgery coupled with (IOL group, n = 12) or without (CL group, n = 13) primary IOL implantation were enrolled in this study. All patients were prescribed half-time occlusion therapy. In July 1999, their grating visual acuities, ocular alignments, and reoperation rates were assessed. Results: The mean grating visual acuity (LogMAR) for the affected eye was 0.70 ± 0.32 for the IOL group and 0.87 ± 0.31 for the CL group (P = .19). The mean interocular difference in grating visual acuity was 0.26 ± 0.30 for the IOL group and 0.50 ± 0.28 for the CL group (P = .048). The incidence of strabismus (>10 PD) was 75% in the IOL group compared with 92% in the CL group (P = .24). The incidence of reoperations was 83% in the IOL group compared with 23% in the CL group (P = .003). Conclusions: Our preliminary data suggest that correcting aphakia after unilateral congenital cataract surgery with primary IOL implantation results in an improved visual outcome but a higher rate of complications requiring reoperation. A randomized clinical trial, the Infant Aphakia Treatment Study, is planned to further study the optimal treatment for aphakia following unilateral cataract extraction during infancy. (J AAPOS 2001;5:70-5)
Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy
JAMA Ophthalmology, 2014
The Infant Aphakia Treatment Study Group IMPORTANCE The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. OBJECTIVE To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. DESIGN, SETTING, AND PARTICIPANTS The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. INTERVENTIONS Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. MAIN OUTCOMES AND MEASURES HOTV optotype visual acuity at 4.5 years of age. RESULTS The median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001). CONCLUSIONS AND RELEVANCE There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212134
Surgical Outcome of Intraocular Lens Implantation in Children with Bilateral Developmental Cataract
BOHR International Journal of Current Research in Optometry and Ophthalmology
Purpose: To evaluate the visual outcome and long-term complications of intraocular lens implantation along with primary posterior capsulectomy & anterior vitrectomy in children with bilateral developmental cataract. Methods: This retrospective study was carried out on the 48 eyes of 24 children who had undergone cataract surgery under general anesthesia. Age range was 2 to 8 years. All patients underwent primary posterior capsulectomy, primary in-bag intraocular lens (IOL) implantation, irrigation-aspiration of lens debris, and anterior vitrectomy. At intervals of one week, one month, three months, and six months, every case was evaluated. After 6 months best corrected visual acuity was recorded and intraocular pressure, anterior chamber angle, optic disc, and peripheral retina were evaluated. Results: Postoperative best corrected visual acuity were 6/6 in 10.4% eyes, 6/9-6/18 in 56.3% and <6/18 in 33% eyes. Intra ocular pressures were found within normal limit (12 ± 2.09 mm of H...