Secondary IOL implantation safe in pediatric patients

Hyderabad, India-Secondary IOL implantation is widely accepted, especially in aphakic patients who have become contact lens intolerant or noncompliant. A number of studies on the topic, mostly from Western countries, have had small sample sizes, and the safety and efficacy of the procedure have not been well studied.

Ramesh Kekunnaya, MBBS, MD, and colleagues from the LV Prasad Eye Institute, Hyderabad, India, retrospectively evaluated the safety and visual outcomes in surgically aphakic children who underwent secondary IOL implantation from January 2000 to December 2010. All secondary IOL implantations were unilateral or bilateral procedures that followed congenital cataract surgery. The patients were followed for longer than 3 months postoperatively.

The study included 174 eyes of 104 children (68 boys; mean age, 6.08 years). The time between the primary surgery and secondary IOL implantation was a mean of 5.6 years (mean follow-up time, 25.7 months).

Two-thirds of the cases were bilateral IOL procedures. Most implantations were in-the-bag procedures, with 80% of cases receiving polymethylmethacrylate IOLs. A scleral tunnel or limbal incision was created for IOL implantation in 66% of the cases.

The patients had a significant (p = 0.0001) improvement in visual acuity at the 3-month examination compared with baseline and the visual acuity increase remained significant (p < 0.0001) at the final visit, Dr. Kekunnaya noted. The data showed that 33% had a best-corrected visual acuity of 20/40 or better, 25% achieved better than 20/100 but worse than 20/40, 19% had better than 20/200 but worse than 20/100, and 23% had worse than 20/200.

In contrast, with the patients who underwent a unilateral procedure, 12% achieved 20/40 or better, and 35% had worse than 20/200.

The most frequently occurring complications in this patient population were secondary membrane formation in about 10%; optic capture in 9%; transient hypotony in 7%, and glaucoma and IOL decentration in about 5% for each-all of which were similar to other such studies, except for optic capture, which was slightly higher in the current study.

Dr. Kekunnaya cited the study strengths: the large sample size and the fact that the study yielded information about secondary IOL implantation in a developing country.

“Secondary sulcus IOL implantation in surgically aphakic children after congenital cataract surgery in infancy is a relatively safe and effective procedure and leads to significant improvement in the visual acuity,” Dr. Kekunnaya concluded.

Dr. Kekunnaya did not indicate any proprietary interest in the subject matter. This article was adapted from Dr. Kekunnaya’s presentation during the 2012 meeting of the American Academy of Ophthalmology.

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