Pediatric intraocular lens implantation. Surgical results and complications in more than 300 patients
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Published on: April 14, 2026
J Zwaan1, P B Mullaney, A Awad
1Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Insights
Pediatric intraocular lens (IOL) implantation in children over 2 years old showed favorable short-term outcomes. Most achieved good vision, with rare major complications, even after trauma.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Biomedical Engineering
Background:
- Pediatric cataracts, including traumatic and infantile types, necessitate intraocular lens (IOL) implantation.
- Accurate refractive outcomes and complication management are critical in pediatric IOL surgery.
Purpose of the Study:
- To review the outcomes of pediatric intraocular lens (IOL) implantations over a 7-year period.
- To evaluate visual acuity, refractive accuracy, and complication rates in children undergoing IOL surgery.
Main Methods:
- Retrospective chart review of pediatric patients (ages 2-16) who underwent IOL placement.
- Data collection included visual acuity, complications, and refractive outcomes using the SRK II formula.
Main Results:
- 71% of patients achieved visual acuity better than 20/80, with 44% reaching 20/40 or better.
- Cataracts were primarily due to trauma (57%) and infantile causes (37%).
- Posterior capsule opacification (39%) and fibrinous membranes (13%) were the most common complications; major complications were rare.
Conclusions:
- Pediatric IOL implantation in children over 2 years old yields favorable short-term visual results.
- Good visual acuity is achievable even in cases of significant penetrating trauma.
- Refractive outcomes were predictable, with a low incidence of significant refractive errors.
Objective:
The study aimed to review pediatric intraocular lens (IOL) implantations performed in the authors' institution for the past 7 years.
Study Design:
The study design was a retrospective chart review.
Participants:
All children who underwent IOL placement between January 1, 1989, and January 31, 1996, at ages 2 to 16 years were studied. Follow-up was a minimum of 6 months up to 4 years with an average of 13 months.
Intervention:
Placement of a primary or secondary posterior chamber IOL was performed.
Main Outcome Measures:
Visual acuity and possible complications were tabulated.
Results:
Fifty-seven percent of the cataracts were caused by trauma, and 37% were infantile cataracts. Visual acuities of 20/40 or better were attained in 44% of eyes and visual acuities of 20/50 to 20/80 were attained in 27% of eyes. Visual acuities were better in children older than 4 years of age (P = 0.001). Compliance with amblyopia therapy improved vision (P = 0.004). Fibrinous membranes occurred in 41 eyes (13%), and posterior capsule opacification occurred in 120 eyes (39%). There were no significant differences in visual outcome and complications between primary and secondary implants (17%) or between capsular bag and sulcus fixation (27%). The first stable postoperative refraction was predicted accurately in most patients, based on the Sanders-Retzlaff-Kraff II (SRK II) formula and intraoperative corneal curvature and axial length determinations. The mean refraction differed from the goal by only +0.28 diopter and 84% were within +/- 2 diopters. A few patients showed large overcorrections or undercorrections. On average, no myopic shift occurred.
Conclusions:
Short-term results of IOLs implanted in children older than 2 years of age were favorable. Visual acuities obtained were better than 20/80 in 71% despite a high prevalence (28%) of penetrating trauma. Major complications were rare.
