Use of AcrySof acrylic foldable intraocular lens for secondary implantation in children

Secondary intraocular lens (IOL) implantation is an increasingly viable option in the management of pediatric aphakia. We report our experience of secondary IOL implantation in pediatric patients using the AcrySof (Alcon Surgical, Fort Worth, Texas) 3-piece foldable lenses through a small incision.

We reviewed the records of all our patients < 18 years undergoing secondary IOL implantation of the AcrySof lens from 1997 to 2001. All patients with a minimum of 6 months follow-up were included. Records were analyzed for age at surgery, postoperative acuity change, postoperative refractive error and anisometropia, surgical complications, and length of follow-up.

Fifty-five eyes of 36 patients were included in the review. Mean age at surgery was 7.4 years (1.1 to 15.4), and mean follow-up was 28 months (6.3 months to 5 years). Vision decrease > 2 lines was noted in 3 eyes (5.8%) during the follow-up period. Complications included IOL decentration in 3 eyes (5%), wound leak in 3 eyes (5%), secondary membrane formation in 5 eyes (9%), pupillary block glaucoma in 1 eye (2%), and ptosis in 1 eye (2%). Four eyes (7%) required reoperation for complications. Mean postoperative refractive error was -0.1 +/- 3.2 diopters (D), and mean anisometropia was 2.01 +/- 1.44 D. Glaucoma subsequently developed in 6 eyes (11%), 2 of which required surgical correction.

Secondary placement of the AcrySof IOL in the ciliary sulcus is a safe and effective method to correct aphakia in pediatric patients with adequate capsular support. The incidence of complications requiring reoperation is low.