Novel ICL: Low adverse events in highly myopic special-needs children

The most common adverse event was pupillary block due to closure of the iridotomy.

Margaret Reynolds, MD, and colleagues from the St. Louis Children's Hospital at Washington University Medical Center, St. Louis, conducted a study to evaluate the safety of the Visian Intraocular Collamer Lens (ICL) (Staar Surgical) in highly myopic special-needs pediatric cases. The most common adverse event was pupillary block due to closure of the iridotomy.

This retrospective case series¹ included 95 special-needs children (160 eyes) with high ametropia who had been implanted with the Visian ICL over the previous 5 years. The surgeries were performed with the children under general anesthesia.

The children were followed for a mean follow-up period of 2.0 ± 1.4 years (range, 0.5-5.2) to determine the safety of the lens in this patient population. The investigators collected the rates and case specifics of perioperative and longer term adverse events.

ICL results

The patients were a mean age of 9.3 ± 5.2 years (range, 1.8-25) at the time the lens was implanted. The mean preoperative spherical equivalent refractive error was −11.20 ± 3.90 diopters (range, 4-22). Of the 95 children, 62 children (65%) had a neurodevelopmental disorder.

A minor adverse event was ocular hypertension in response to steroids that occurred in 3 eyes (2%) and resolved when the steroids were stopped.

The most frequently occurring major adverse event was postoperative pupillary block that required revision of the peripheral iridotomy in 7 eyes (4%).

Other adverse events that developed in 1 eye each (0.6%) included a wound leak in a 1 child who was self-injurious and required repair; a cataract in 1 child with Down syndrome 2.8 years after the ICL surgery, and a traumatic retinal detachment in 1 child with severe autism spectrum disorder 1.2 years after the ICL implantation.

The endothelial cell loss over the follow-up period averaged 8.1%, which was comparable to that in adults implanted with the ICL.

Reynolds commented, “The rate of adverse events was low in this higher risk, difficult-to-manage population of special-needs children.”

Reference

1. Reynolds M, Hoekel H, Tychsen L. Safety of phakic intraocular collamer lens implantation in 95 highly myopic special-needs children. J Cataract Refract Surg. 2021;47:1519-1523; doi: 10.1097/j.jcrs.0000000000000678