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Primary IOL implantation in children: a risk analysis of foldable acrylic v PMMA lenses
N A Rowe1, S Biswas, I C Lloyd
1Department of Paediatric Ophthalmology, Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WH, UK.
Insights
This study compared poly (methylmethacrylate) (PMMA) and soft acrylic intraocular lenses (IOLs) in pediatric cataract surgery. Soft acrylic IOLs may lead to fewer complications, but both IOL types show comparable short-term safety.
Area of Science:
- Ophthalmology
- Biomaterials Science
- Pediatric Surgery
Background:
- Cataract surgery in children requires careful consideration of intraocular lens (IOL) material.
- Poly (methylmethacrylate) (PMMA) and soft acrylic IOLs are common choices for primary implantation.
- Understanding the relative risks associated with each IOL type is crucial for pediatric patients.
Purpose of the Study:
- To compare the risks of primary poly (methylmethacrylate) (PMMA) versus soft acrylic (AcrySof) intraocular lens (IOL) implantation in pediatric cataract surgery.
- To evaluate perioperative complications and the need for subsequent intervention for posterior capsule opacification (PCO).
Main Methods:
- Retrospective analysis of clinical data from 61 infants and children undergoing cataract surgery with primary IOL implantation.
- Comparison of perioperative complications and interventions for PCO between PMMA and acrylic IOL groups.
- Statistical analysis including odds ratios, survival analysis, and Cox regression to assess risks and adjust for confounding factors.
Main Results:
- PMMA IOLs were significantly associated with increased perioperative complications compared to acrylic IOLs (OR 5.2, p=0.01), potentially due to larger scleral wounds.
- No statistically significant difference in the risk of subsequent intervention for PCO was found between PMMA and acrylic IOLs.
- Short-term data indicated comparable safety profiles, with no significant difference in the relative risk of intervention after acrylic IOL implantation after adjustment for confounding factors.
Conclusions:
- Primary implantation of soft acrylic IOLs may be associated with fewer perioperative complications in pediatric cataract surgery compared to rigid PMMA IOLs.
- The short-term safety profiles of PMMA and soft acrylic IOLs are comparable for primary implantation in pediatric cataract patients.
- Further research may be warranted to explore long-term outcomes and specific indications for each IOL type.
Background:
/aims: To compare the relative risks of poly (methylmethacrylate) (PMMA) and soft acrylic (AcrySof) primary intraocular lens (IOL) implantation in paediatric cataract surgery.
Methods:
A retrospective analysis of clinical data was performed on eyes of 61 infants and children who underwent cataract surgery with primary IOL implantation. Age at operation ranged from 3 weeks to 15 years. Mean follow up duration was 24.5 months (range 0.5-68 months). Factors examined included type of IOL (PMMA, acrylic), performance of a primary posterior continuous curvilinear capsulorhexis (PCCC) or capsulotomy with limited anterior vitrectomy, perioperative complications, and subsequent intervention for posterior capsule opacification (PCO). Risk factors for perioperative complications were examined with 2x2 tables to give odds ratios (OR) as measures of association. A survival analysis was performed to assess risk of subsequent intervention for PCO with different IOL types. Relative risks (hazards) and confidence intervals (CI) were calculated with Cox regression to adjust for potential confounding.
Results:
Compared to acrylic, PMMA IOLs were significantly associated with perioperative complications (OR 5.2, 95% CI 1.4 to 19, p = 0.01). However, IOL and type of section were highly correlated factors, and this finding may reflect risks associated with larger scleral wounds used for PMMA IOLs. No statistically significant difference in risk of subsequent intervention for PCO was found between different IOL types. Mean times till intervention for PMMA and acrylic IOLs were 30.1 months (95% CI 22 to 38) and 19.8 months (95% CI 12 to 27) respectively (log rank test statistic 1.53, one degree of freedom, p = 0.22). At 12 months post-implant surgery, 76% (95% CI 59 to 93) of PMMA cases and 54% (95% CI 35 to 72) of acrylic cases had not required intervention for PCO; these proportions fell to 55% (95% CI 35 to 75) and 38% (95% CI 14 to 61) for PMMA and acrylic cases respectively at 2 years post-surgery. After adjustment for age at surgery, primary posterior capsulorhexis, and perioperative complications relative risk of intervention after acrylic IOL implantation was 1.6 (95% CI 0.66 to 3.9, p = 0.29).
Conclusion:
Primary implantation of foldable soft acrylic IOLs in paediatric eyes may allow fewer perioperative complications than rigid PMMA IOLs. Short term safety profiles of primary implantation in paediatric cataract surgery are otherwise comparable for PMMA and soft acrylic IOLs.
