Outcomes of rigid gas permeable contact lens correction in paediatric aphakia

This study aimed to assess visual outcomes, tolerance, and adverse events in paediatric aphakia following lensectomy when managed with rigid gas-permeable contact lenses worn on a 7-day extended-wear schedule.

A retrospective chart review was conducted of children undergoing lensectomy at the [redacted for review] Hospital from 1 January 2014 to 1 January 2021. Children whose aphakia was corrected with rigid gas-permeable contact lenses following lensectomy were included. Children corrected with a primary intraocular lens were excluded. Ophthalmic follow-up data were analysed up to 1 September 2024.

A total of 113 aphakic eyes (73 children) were included. Forty children had bilateral lensectomies and 33 had unilateral lensectomies. Median age at lensectomy was 19 weeks (range 4.5 weeks-11.0 years; IQR 3.3 years). Median ophthalmic follow-up was 5.5 years (range 0.4-9 years; IQR 3.2 years). Median post-operative visual acuity was better in the bilateral lensectomy group (logMAR 0.3) compared to the unilateral group (logMAR 1.1) (Mann-Whitney U = 1370.5, p < 0.001). Corneal infiltrative events occurred in 5.3% of eyes (n = 6; 0.97 cases per 100 eye-years) and all resolved with topical treatment, with no visually significant sequelae documented. At final review, 63% of children were still wearing rigid gas-permeable contact lenses as their primary aphakic correction. Secondary intraocular lens implantation occurred at a median age of 4.7 years.

Rigid gas-permeable contact lenses worn on a 7-day extended-wear schedule remained a viable optical correction for many children over long-term follow-up; however, the observed rate of corneal infiltrative events underscores the need for vigilant follow-up and caution with overnight wear. Children with bilateral aphakia demonstrated better visual outcomes than those with unilateral aphakia, which is consistent with the known amblyogenicity of unilateral visual deprivation in childhood.