IOL implantation appears safe in babies, toddlers

This retrospective study examined the safety profile of primary intraocular lens (IOL) implantation in children younger than two years old. The authors followed the study's 80 subjects (120 eyes) for a mean of 8.85 months, finding that there were no refractive surprises, low rates of complications and no cases of glaucoma, endophthalmitis or retinal detachment. There was no difference in the rate of complications between children younger and older than six months of age. They say the results suggest that IOL implantation in children younger than two years of age is safe and, with proper case selection, can be considered a primary option for their visual rehabilitation.

The study included all children younger than age two with congenital/developmental cataract who underwent primary IOL implantation between January 2006 and December 2007 at one pediatric ophthalmology center. They ranged in age from 1 to 23 months. Thirty-one eyes were operated on before the age of six months. The axial length of all of the eyes ranged from 16.27 to 25.65 mm (mean 19.84 ± 1.71). The IOLs implanted ranged in power 11 D to 30 D (mean 24.51 ±4.06 D). Thirty eyes were implanted with rigid polymethylmethacrylate (PMMA) lenses; the remaining 90 received acrylic hydrophobic foldable lenses.

Eight eyes (6.7 percent) developed opacification of the visual axis. Slight IOL decentration that was not visually significant and did not require surgical repositioning was noticed in two (1.7 percent). Increased anterior chamber inflammation was observed in five (4.2 percent) during the early postoperative period. Pigment dispersion on IOL was seen in four eyes (3.3 percent). Posterior synechiae were noticed in five eyes (4.2 percent). There was no difference in the incidence of complications in patients implanted with different IOL types.

The authors say that the lack of early-onset glaucoma in this study could be due to implantation of foldable lenses in the majority. In the rigid lens group, this might be because of the smaller diameter of the PMMA lenses and implantation mainly in older children (median age 13.5 months).

The authors say that although the study is limited by its retrospective design and short-term follow up (median six months), the results are encouraging due to the reduction in the rates of various complications compared with previous studies. They advise that lifelong follow-up is still warranted in these children in order to detect problems early and manage any complications encountered.