Loading ...

TOPLINE:

Children with nontraumatic cataracts undergoing implantation of a secondary intraocular lens (IOL) after lensectomy are at a risk for complications including a diagnosis of glaucoma and visual axis opacification, refractive errors, and poor vision.

METHODOLOGY:

• Researchers evaluated complications, refractive errors, and visual activity in infants and young children with nontraumatic cataracts who received a secondary IOL.
• They included 108 aphakic eyes from 80 children (60 bilateral and 48 unilateral cases) with nontraumatic cataracts who underwent lensectomy followed by secondary IOL implantation.
• Primary outcomes were the incidence of complications, changes in refractive error, and visual acuity.
• The median follow-up before secondary IOL implantation was 2.5 years and 1.7 years for bilateral and unilateral cases, respectively. The median follow-up after secondary IOL surgery was 2.6 years and 2.4 years for bilateral and unilateral cases, respectively.

TAKEAWAY:

• Within 3 years of secondary IOL implantation, glaucoma or a suspected glaucoma occurred in 17% (95% CI, 3%-29%) of bilateral and 12% (95% CI, 0%-23%) of unilateral cases, respectively. Rates of visual axis opacification were 14% (95% CI, 5%-23%) and 16% (95% CI, 4%-27%), respectively.
• The refractive index outcome was less farsighted than the target set at the time of lensectomy; the median difference was 0.88 D among 21 eyes for bilateral cases and 1.50 D among 19 eyes for unilateral cases.
• At 5 years, median spherical equivalent refractive error was +0.50 D for 48 bilateral cases and +0.06 D for 22 unilateral cases, and median myopic shift was −2.00 D and −2.69 D, respectively.
• The median visual acuity was 20/63 for 42 bilateral cases and 20/400 for 33 unilateral cases; five and two eyes, respectively, met criteria for age-normal visual acuity.

IN PRACTICE:

"Eyes receiving secondary IOL implantation have an ongoing risk of new glaucoma-related adverse events by 3 years," according to the authors. Refractive error at implantation was less hyperopic than desired, they added, which "may account for the minimal hyperopia found at about 5 years of age and raises concern that myopia may develop."

SOURCE:

The study was led by Serena Wang, MD, of the University of Texas Southwestern Medical Center in Dallas, and was published online on May 15, 2024, in Ophthalmology.

LIMITATIONS:

The study was limited by a small sample size, and the confidence intervals did not dismiss the potential of a modest effect of secondary IOL implantation on the risk for glaucoma-related adverse event, in either direction. Preoperative visual acuity was not available. Moreover, analyses on refractive error were reported only according to age at secondary implantation and not according to age at lens extraction.

DISCLOSURES:

The study was supported by the National Eye Institute of the US National Institutes of Health. The authors declared no conflicts of interest.