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Predictors of early secondary IOL implantation after pediatric cataract surgery
W Garrett Hayes1, M Edward Wilson1, Rupal H Trivedi1
1Storm Eye Institute, Medical University of South Carolina, Charleston.
Insights
Pediatric aphakia often requires early intraocular lens (IOL) implantation, particularly in unilateral cases. Contact lens failure is a common reason for this early intervention in children needing IOLs.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Pediatric aphakia, a condition of lacking a natural lens, is typically managed with contact lenses or spectacles.
- Secondary intraocular lens (IOL) implantation is often delayed until the child is older.
- However, some pediatric aphakic patients require earlier IOL implantation.
Purpose of the Study:
- To determine the frequency and reasons for early secondary IOL implantation in pediatric aphakia.
Main Methods:
- Retrospective review of medical records for patients with aphakia post-infancy cataract surgery.
- Inclusion criteria: patients seen at or after 4 years of age.
- Definition of early implantation: occurring before 4 years of age.
Main Results:
- 175 patients met inclusion criteria.
- 24% of unilateral cases (22/90) had early IOL implantation versus 12% of bilateral cases (10/85) (OR 2.43).
- Contact lens failure (81%) was the primary driver for early IOL implantation, with nonmedical reasons cited in 27% of failures.
Conclusions:
- Unilateral aphakia is significantly associated with an increased risk of early IOL implantation.
- Contact lens intolerance or failure is a major factor necessitating earlier IOL intervention.
Background:
Pediatric aphakia may be treated conservatively with aphakic contacts or spectacles. Many families and surgeons opt for a secondary intraocular lens (IOL) when the child is older. In certain situations, pediatric aphakic patients must undergo implantation earlier than planned. The purpose of this study was to investigate how often and why early implantation occurs.
Methods:
We retrospectively reviewed the medical records of consecutive patients who were left aphakic after cataract surgery in infancy and were seen at our institute at ≥4 years of age. Early implantation was defined as occurring at <4 years of age.
Results:
A total of 175 patients fit inclusion criteria. We found that 22 of 90 patients (24%) with unilateral cataracts had undergone early secondary IOL implantation before 4 years of age compared to 10 of 85 patients (12%) with bilateral cataracts, a statistically significant difference in the relative risk of early implantation (OR 2.43 [95% CI 1.07-5.49]). Of our patients undergoing early implantation, 15 of 31 (44%) had Medicaid as the primary insurance provider, which is representative of the practice overall. In patients requiring early implantation, failure with contact lens accounted for 26 of 32 cases (81%), with 7 of 26 (27%) of these failures attributed to nonmedical reasons.
Conclusions:
Of the factors we analyzed, only the presence of unilateral aphakia was associated with increased risk of early IOL implantation in our study cohort.
