IOL implantation in early infancy not advised

This analysis of Infant Aphakia Treatment Study data found no visual benefit from implanting an IOL at the time of unilateral cataract surgery in infants younger than seven months. Furthermore, children who had IOL implantation had more adverse events and required more reoperations to clear visual axis opacities than those given contact lenses.

Subjects included 114 infants aged six months or younger with unilateral congenital cataracts randomized to contact lenses or IOLs following unilateral cataract surgery. A traveling examiner assessed visual acuity in the subjects at age 4.5 years.

There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group.

The authors conclude that when operating on an infant younger than seven months with a unilateral cataract, it is better to leave the eye aphakic and focus it with a contact lens. Primary IOL implantation should be reserved for infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia.