Intraocular lens implantation in children

Over the past 15 years, lens implant surgery in children has disseminated so much that it is no longer a controversial issue. It has become rather a specialized topic in the widespread field of lens implantation in the general population. To match the excellent results seen in adults, issues such as the surgical technique, the choice of the lens, and dioptric power of that lens, are constantly being refined and adapted to children's growing eyes. Scleral tunnels and small, self-sealing corneal incisions are being replicated in children to benefit from their advantages. Polymethyl methacrylate material remains unrivalled from the point of view of safety and longevity in the human eye. Intraocular lenses (IOLs) with an overall diameter of 12 mm can safely be used in nonmicrophthalmic eyes of children more than 3 years of age. Several investigators now recognize the need for smaller pediatric IOLs for neonates, toddlers, and microphthalmic eyes. Fortunately, modern IOLs are smaller today than they were 15 years ago. The accumulating evidence on the myopic shift that occurs in pseudophakic children have led to an almost unanimous agreement that the IOL power should aim for a certain amount of hypermetropia at time of surgery. The residual refractive error can be corrected with spectacle glasses that are adjusted throughout childhood. The goal is to start with hypermetropia in childhood that will convert into emmetropia or mild myopia in adulthood.