IOLs in cataract surgery – do the risks outweigh the benefits in infants?

Take-home message: This article presents recent epidemiological findings outlining the association between cataract surgery, potential visual acuity gains, glaucoma and the risk of undergoing additional general anaesthesia in under 2s. The authors of the original study concluded that use of IOLs in cataract surgery in young children should be critically reassessed, particularly in settings/communities where close, long-term follow-up is challenging.

 

By Faye Emery, OTE Editor, Reviewed by Dr Ameenat Lola Solebo and Prof. Jugnoo S. Rahi

Congenital and infantile cataract accounts for up to a fifth of the world’s 1.4 million blind children.¹ When cataract occurs in children under 2, clinicians are faced with the challenge of undertaking surgery in the proinflammatory infant eye, during its most fundamental growth and development period.

Did you know these 7 men were ophthlamologists?  

In most resource-rich countries, the introduction of whole population screening has been implemented to ensure earliest possible detection of cataract (e.g., the UK’s National Screening Committee’s Newborn and Infant Physical Examination programme).²

According to the early adopters of intraocular lenses (IOLs) in infancy, there are 3 theoretical advantages:

• The potential for permanent in situ correction to offer better visual rehabilitation, which is thought to be especially important in children with unilateral cataract; in these children amblyopic deprivation is particularly strong due to rivalry from the unaffected eye.

• A reduction in the requirement for regular clinic visits to update contact lenses, and in the infection risk in developing countries, where access to clean water is limited.

• A possible reduction in the risk of postoperative glaucoma, a complication of cataract surgery in children.

In response to a lack of robust evidence on IOL outcomes for young children with bilateral and unilateral cataract, a population-based cohort study (IOLunder2) was conducted, which set out to investigate visual and adverse outcomes following cataract surgery (both with and without primary IOL implantation), in children under 2 with congenital or infantile cataract. The study was conducted in the British Isles through the British Isles Congenital Cataract Interest Group (BCCIG), a network of ophthalmologists specialising in congenital and infantile cataract.

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