IOL implantation relatively safe in children ages 6 months to 2 years

This study evaluated the outcomes of unilateral cataract surgery in children ranging from 7 to 24 months of age.

Study design

The Toddler Aphakia and Pseudophakia Study (TAPS) is a retrospective consecutive case series of pediatric cataract surgeries performed by investigators who were simultaneously enrolling younger babies in the Infant Aphakia Treatment Study (IATS). The TAPS included premature infants while the IATS excluded them.

Outcomes

The authors reviewed records from 56 eyes. Primary posterior capsulotomy and anterior vitrectomy were performed in 98% of eyes, and 92% of eyes received a primary IOL. Intraoperative complications included inadvertent capsular disruption in 5 eyes; in each case, an IOL was inserted. Eleven percent of patients demonstrated visual acuity better than 20/40 in the affected eye, while 44% demonstrated visual acuity of 20/200 or worse. Adverse events occurred in 24% of patients, with visual axis obscuration being the most common finding. An additional unplanned intraocular surgery occurred in 14% of children; no patient underwent a glaucoma procedure.

Limitations

This study is retrospective in nature. The use of nonrandomized patients and non-standardized documentation limits the interpretation of the findings.

Clinical significance

The rate of complications, reoperations and adverse effects after unilateral primary IOL implantation is lower in older infants and toddlers than in young infants. This study supports the relative safety of IOLs in infants ranging from 7 to 24 months of age.