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  • Children with multifocal and monofocal IOLs share similar visual development

    Cataract/Anterior Segment, Pediatric Ophth/Strabismus

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    Review of: Comparative analysis of visual outcomes of multifocal and monofocal intraocular lenses in congenital cataract surgery

    Buzzonetti L, Petroni S, De Sanctis C, et al. Journal of Cataract & Refractive Surgery, January 2022

    Investigators used a retrospective interventional consecutive case series to assess the impact of multifocal vs. monofocal intraocular lens (IOL) implantation on children’s visual development following congenital cataract surgery.

    Study design

    The records of 56 eyes of 43 children aged ≤1 year who underwent IOL implantation at a children’s hospital in Italy were reviewed; 32 multifocal (18 unilateral, 14 bilateral) and 24 monofocal (12 unilateral and 12 bilateral) IOLs were implanted. The authors measured corrected distance visual acuity (CDVA), refractive error, and ocular motility for >4 years of follow-up.

    Outcomes

    The mean follow-up was 6.7 years. The mean CDVA was 0.75 logMAR and 0.34 logMAR in eyes with unilateral vs. bilateral multifocal IOL implants, respectively, and 0.71 logMAR and 0.53 logMAR in eyes with unilateral vs. bilateral monofocal IOL implants, respectively. Sixty percent of patients showed postoperative strabismus.

    Limitations

    This study included a small number of patients due to the rarity of congenital cataracts.

    Clinical significance

    Multifocal IOLs did not show significant advantages in visual development over monofocal IOLs. A large number of issues remain to be elucidated with regard to multifocal IOLs in young children. Some of these issues include the changing refractive status of the growing eye, how reduced contrast sensitivity in the eye implanted with a multifocal lens could actually worsen amblyopia, and the effects of possible decentration of the IOL associated with capsular phimosis.