Primary IOL implantation yields favorable outcomes in children over 2

October 25, 2004

New Orleans-Results of a retrospective study support the conclusion that primary IOL implantation in pediatric cataract patients aged 2 years and older results in excellent visual outcomes, said Edward Wilson Jr., MD.

"Primary implantation of an IOL in this age group is considered the standard of care by pediatric surgeons in this country even though it is off-label. Now, we would like to see these and other pooled outcome data used to seek FDA approval of IOLs in children aged 2 years and older," said Dr. Wilson, Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston.

His study included 125 consecutive eyes of children aged 2 to 19 years old with cataracts other than traumatic in origin. The patients had a median age of about 6 years, about one-third of the group had unilateral cataracts, and the mean duration of follow-up was 6.1 years.

At the last visit, median visual acuity was 20/27 for the entire group and was slightly better in those who had bilateral versus unilateral cataract surgery, 20/25 versus 20/30. In addition, patients with unilateral cataracts had a 4.6-fold increased risk of having a postoperative visual acuity of 20/60 or less compared with their bilateral cataract counterparts. The difference in visual outcomes reflected the fact that amblyopia is more common in children with unilateral versus bilateral cataracts.

"We are so used to hearing about the dismal outcomes of primary IOL implantation in pediatric cataracts, especially in very young children with a unilateral condition, that it is good to remind ourselves about how good the results can be in older patients," Dr. Wilson said.