Skip to main content

  • Three-Piece IOLs Reduce VAO Risk After Pediatric Cataract Surgery

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
    Add to My Bookmarks

    Journal Highlights

    Ophthalmology, September 2022

    Download PDF

    Küchlin et al. looked at the time course of secondary visual axis opacification (VAO) leading to surgery after primary IOL implantation in children, as well as the type of lenses associated with the recurrence. In their study of 135 eyes, VAO occurred in 13, and the median time to recurrence was 10 months following the primary surgery. Ten of the 13 eyes had received a one-piece in-bag IOL.

    This was a single-center study of children (1-14 years old) who had un­dergone cataract surgery with implan­tation of an IOL. The same surgeon performed all procedures. The surgical technique was either bag-in-lens place­ment or in-bag placement with prima­ry posterior capsulotomy and anterior vitrectomy. Eyes with major visual ocular comorbidities were excluded. Main outcome measures were surgi­cal complications and the proportion of eyes without VAO recurrence that required clearing of the visual axis after the initial procedure. VAO-free survival by type of lens/technique was assessed using Kaplan-Meier methodology and a Cox proportional hazards model with predefined adjustments for age at sur­gery, year of surgery, and the German Index of Socioeconomic Deprivation (score by postal code). To lengthen the follow-up time, patients were invited to attend a clinical visit.

    Ninety-five children (135 eyes) met the inclusion criteria. Of these eyes, 64 received an acrylic three-piece IOL, 51 had an acrylic single-piece IOL, and 20 had an acrylic single-piece bag-in-lens IOL. The respective mean ages at surgery were 53 months, 52 months, and 60 months. The median follow-up period was 19 months. There were 13 cases of VAO, which occurred at a me­dian of 10 months post-op (interquar­tile range, 10-12 months). Ten of these eyes had a one-piece in-bag IOL, two had a bag-in-lens IOL, and one had a three-piece in-bag IOL. Compared with three-piece in-bag IOLs, the adjusted hazard ratios were 32.8 for one-piece acrylic IOLs (p = .003) and 19.6 for bag-in-lens IOLs (p = .036). Two eyes with bag-in-lens surgery (10%) had an iris capture. There was one case of endophthalmitis and no cases of post­operative retinal detachment or new glaucoma.

    In this study, VAO that required a clearance procedure usually occurred within 15 months of the original surgery. Opacification rates were lowest with three-piece acrylic bag-in-lens IOLs. The lack of retinal detachment or new glaucoma in this study may be due partly to follow-up loss or the small, re­stricted study sample, said the authors. Regardless, their data corroborate many findings of earlier studies, including the age-dependent nature of VAO, the timeline to VAO recurrence, and the influence of lens type. The authors emphasized paying special attention to lens selection in young patients with cataract, especially given their vulnera­bility to VAO and amblyopia.

    The original article can be found here.