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Lola A. Solebo, Jugnoo S. Rahi, British Isles Congenital Cataract Interest Group; IOLunder2: Outcomes Following Surgery With And Without Primary Intraocular Lens Implantation In Children under 2years Old. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6769.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate outcomes following cataract surgery in children <2years
A bi-national prospective observational cohort study undertaken through a collaborative research network, with standardised data collection on children undergoing cataract surgery with and without IOL implantation between Jan ‘09 - Dec ’10, with multivariate multilevel logistic regression analysis of potential predictors of outcome.
Outcome data are available for 147 (89 bilateral cataract, 58 unilateral cataract) of the 252 children recruited to date.Co-existent ocular anomalies were common: persistent fetal vasculature in 8% bilat., 47% unilat. cataract; axial length <16mm in 23% bilat., 8% unilat. cataract; HCD<9.5mm 10% bilat., 3% unilat. cataract eyes.Outcomes at 1 year following surgery:Vision within normal range for age in 31% children with bilat. cataract, 22% operated unilat. cataract eyesSurgery for visual axis opacity (VAO) had been undertaken in 24% eyes bilat., 50% unilat. cataractPost-operative glaucoma diagnosed in 10% eyes bilat., 8% unilat. cataractAlthough younger age at surgery was associated with better visual outcome, surgery in the first month of life was not associated with better visual outcome but was associated with an increased risk of glaucoma (OR 1.75, 95%CI 1.2-1.9, p<0.01).Primary IOL implantation was undertaken in 41/89 children with bilat. and 36/58 unilat. cataract. IOL implantation was not associated with the risk of postoperative glaucoma but was associated with:Better visual outcome following surgery for bilat. cataract (in eyes with no co-existent ocular anomaly) but not with better vision in unilat. cataract eyesHigher odds of VAO surgery following surgery for both bilat. (OR:7.1, 95%CI 2.4-22, p<0.01) and unilat. cataract (OR:6.3, 95%CI 2-19, p<0.01)and single piece IOL was associated with higher odds of VAO surgery independent of IOL power / age of child.47% pseudophakic bilat. cataract eyes and 47% unilat. cataract eyes achieved an initial refraction within 1D of planned outcome.
Primary IOL implantation often commits children to early re-operation requiring repeat general anaesthetic during the crucial neurological developmental period, but may confer visual benefit in bilateral cataract. The size of the full IOLu2 cohort will enable further analysis of the predictors of visual, adverse and refractive outcome.
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