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Lola Solebo, Isabelle Russell-Eggitt, Jugnoo Rahi, British Isles Congenital Cataract Interest Group; IOLunder2 study: outcomes following surgery with and without primary intraocular lens implantation in children <2years old. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5672.
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© ARVO (1962-2015); The Authors (2016-present)
Investigate clinical and functional outcomes of surgery in children <2 with congenital/infantile cataract.
A national prospective observational cohort study undertaken through the BCCIG, a collaborative research network. Standardized data collection on children undergoing surgery between January 2009 - December 2010. Multivariable multilevel regression analysis to identify predictors of outcome.
1 year post-operative outcomes data are available on 221 children (131 bilateral cataract:BC, 90 unilateral cataract:UC). Ocular comorbidity was common: persistent fetal vasculature in 47% UC, 8% BC; axial length <16mm in 23% BC, 8% UC; horizontal corneal diameter<9.5mm 10% BC, 3% UC. 56/131 BC and 48/90 UC children had primary IOL implantation. Implantation was more common in more socioeconomic deprived children (49% v 31%, p=0.01). Outcome at 1 year after surgery: - Vision in normal range for age in 31% of all children with BC and 22% all operated UC eyes, and also in normal range in 49% BC children and 31% UC eyes without ocular co-morbidity or cerebral visual impairment - Additional surgery for visual axis opacity (VAO) in 24% all BC & 50% all UC eyes - Postoperative glaucoma in 10% all BC, 9% all UC eyes, additionally ocular hypertension in 6% BC, 16% UC - 47% of pseudophakic BC eyes and 47% of UC eyes achieved early refraction within 1D of planned outcome. Primary IOL was not independently associated with either visual outcome or postoperative glaucoma, but was associated with VAO (OR:6.7, 95%CI 1.7-26, p=0.006 in BC, OR:6.2, 95%CI 1.1-35, p<0.05 in UC ), where VAO was more likely with single piece IOLs (OR 43.7, 95%CI 1.4-9.7, p<0.01).
Primary IOL implantation in children under 2 does not appear to confer any visual benefit in the first post-operative year, nor alter the high risk of aphakic/pseudophakic glaucoma but often commits children to early re-operation requiring repeat general anaesthetic during the crucial neurological developmental period. Planned follow-up of the IOLunder2 cohort will provide currently unavailable data on predictors of favourable and adverse long term outcomes.
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