Visual outcomes after secondary IOL implantation in aphakic children

According to physicians, patients who do not undergo second procedure are more likely to develop glaucoma.

The finding of the low level of hyperopia seen at a median of 5.1 years of age suggested that patients will become myopic as they get older.

Aphakic children who underwent a previous procedure to remove a nontraumatic cataract and then underwent a secondary intraocular lens (IOL) surgery had minimal complications associated with the secondary IOL implantation. However, the children who had the initial surgery and did not undergo IOL implantation had a higher risk of glaucoma, according to Serena Wang, MD, of the Department of Ophthalmology, University of Texas, Southwestern Medical Center, Dallas.

Wang presented the results of this study on behalf of the Pediatric Eye Disease Investigator Group at the recent American Academy of Ophthalmology 2022 annual meeting in Chicago.

Study cohort

Wang, the lead study author, and colleagues sought to establish the incidence rates of complications and the refractive errors and visual outcomes in this population of children undergoing secondary IOL implantation.

The study included patients who were younger than 13 years of age and had no history of a nontraumatic cataract or glaucoma. The primary outcomes after secondary IOL implantation were the spherical equivalent refractive error (SERE) and the visual acuity (VA) at 5 years of age and the cumulative risk of complications at 3 years, Wang explained.

Eighty aphakic patients (108 eyes) were included in the study; 60 eyes were those of patients who had bilateral cataracts and 48 were eyes of those who had unilateral cataracts. The primary lens surgeries had been performed at a median patient age of 2 months and the secondary IOL surgery at a median age of 2.4 years. The 5-year follow-up after lensectomy was at a median of 2.5 years after the secondary IOL surgery. The refractive error, VA, and cumulative incidence of complications were assessed at the 5-year follow-up evaluation.

The authors reported that the median SERE was +0.50 diopter (D) (interquartile range [IQR], −2.38 to +2.94 D in those with bilateral cataracts) and +0.06 D (IQR, −2.25 to +0.75 D in those with unilateral cataracts). The median VA was 20/63 (IQR, 20/50-20/100 in those with bilateral cataracts) and 20/400 (IQR, 20/160-20/800 in those with unilateral cataracts).

Complications reported

The most frequent complications within 3 years after secondary IOL implantation were glaucoma in 15% and 9% of those with bilateral and unilateral cataracts, respectively, and glaucoma-related adverse events in 17% and 12%, respectively.

At a median age of 2.4 years, minimal complications developed in association with secondary IOL implantation. The investigators pointed out that eyes that were aphakic following lensectomy and those that underwent implantation of a secondary IOL have an ongoing risk of development of new glaucoma-related adverse events by 3 years of age.

The finding of the low level of hyperopia seen at a median of 5.1 years of age suggested that patients will become myopic as they get older.

The authors advised that future studies be undertaken to determine the ideal targeted level of hyperopic refractive error based on the patients’ age at the time of the secondary IOL implantation.

Serena Wang, MD

E: serena.wang@southwestern.edu

Wang is a professor of ophthalmology at the University of Texas, Southwestern Medical Center, Dallas. She has no financial disclosures related to the content of this report.

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