Primary Intraocular Lens Implantation in Children 2 Years Old: Survey of Current Practice

Abstract

Purpose: : To investigate the current management of children ≤2 with visually significant congenital or infantile cataract, as the foundation for a national study of the outcomes of primary intraocular lens (IOL) implantation in this age group in the UK and Eire (UK&I).

Methods: : A postal questionnaire survey of all consultant ophthalmologists in the UK&I to determine practice, including exclusion criteria for primary IOL implantation & surgical technique, in children ≤2 with cataract.

Results: : 71% (684/960) of surveyed ophthalmologists replied. Of the 45 respondents who operated on children, 39 (87%) performed primary IOL implantation. These 39 operated on 243 (total) children over a 1 year period, implanting IOLs in 159 (65%). 89% and 87% of surgeons implanting IOLs created limbal wounds and continuous circular capsulorhexis respectively. 92% implanted Acrysof hydrophobic IOLs. The SRK/T equation was most commonly used (67%) to calculate power. Surgeons implanted between 17 and 100% of children on whom they operated. Exclusion criteria for primary IOL implantation varied considerably and included microphthalmos (49% of respondents), glaucoma (21%), persistent hyperplastic primary vitreous (21%) and age under 6 months (15%).

Conclusions: : Our findings show that primary IOL implantation in children ≤2 has been increasingly adopted in the UK and Eire, with concordance of practice in regards to surgical technique, choice of IOL model and power calculation formula. However, variation exists in eligibility criteria for primary IOLs: this may reflect a lack of consensus on which children are most likely to benefit from this intervention. Thus there is a need for systematic studies of the outcomes of primary IOL implantation in younger children.

Keywords: cataract • intraocular lens • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials