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Anisometropia at Age 5 Years After Unilateral Intraocular Lens Implantation During Infancy in the Infant Aphakia

David Weakley1, George Cotsonis2, M Edward Wilson3

  • 1Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.

American Journal of Ophthalmology
|May 21, 2017
PubMed

Insights

Most infants who received intraocular lens (IOL) implantation for unilateral cataracts developed significant anisometropia by age 5. Glaucoma further increased this refractive difference, highlighting challenges in infant eye care.

Area of Science:

  • Ophthalmology
  • Pediatric Ophthalmology
  • Refractive Error

Background:

  • Unilateral congenital cataracts require early intervention, often involving intraocular lens (IOL) implantation.
  • Achieving emmetropia in infants post-IOL implantation is complex due to ongoing eye growth and refractive changes.
  • Anisometropia, a significant difference in refractive error between eyes, is a common concern after pediatric cataract surgery.

Purpose of the Study:

  • To determine the prevalence of anisometropia at age 5 years in infants treated for unilateral cataracts with IOL implantation.
  • To investigate factors influencing anisometropia, specifically the impact of developing glaucoma.

Main Methods:

  • Prospective randomized clinical trial within the Infant Aphakia Treatment Study (IATS).
  • Fifty-seven infants with unilateral cataracts underwent randomized IOL implantation targeting either +8D or +6D postoperative refractive error based on age at surgery (28 to <48 days or 48-210 days, respectively).
  • Anisometropia was assessed at age 5 years; 6 patients were excluded from analysis.

Main Results:

  • The majority of pseudophakic eyes exhibited significant anisometropia by age 5 years, with a median anisometropia of -3.50D (IQR -8.25D to -0.88D).
  • Patients who developed glaucoma in the treated eye showed significantly greater anisometropia (median -8.25D) compared to those without glaucoma (median -2.75D; P=0.005).
  • Refractive errors at age 5 years were -2.25D (IQR -5.13D to +0.88D) in treated eyes and +1.50D (IQR +0.88D to +2.25D) in fellow eyes.

Conclusions:

  • Significant anisometropia is prevalent at age 5 years following unilateral IOL implantation in infants with cataracts.
  • The development of glaucoma in the treated eye is associated with increased anisometropia.
  • Variability in infant eye growth and myopic shift presents ongoing challenges for achieving optimal refractive outcomes with early IOL implantation.
Abstract

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