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F. Liang, P. Dureau, C. Edelson, F. Metge, P. De laage de Meux, G. Caputo; Primary Intraocular Lens Implantation for Bilateral Congenital Cataracts in Infants 0-1 Year Old: Long-Term Anatomic and Visual Outcome. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4561.
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Primary intraocular lens (IOL) implantation is controversial in young infants for the correction of aphakia. Small case series showed moderate better visual outcome than aphakic groupe, but more postoperative complications than older children.The aim of this study was to assess the long-term anatomic and visual outcome of cataract extraction with primary IOL implantation in infants < 1 year old.
We retrospectively reviewed 86 eyes of 43 infants younger than 1 year operated for bilateral congenital cataract from 1999 to 2006. The surgical procedure was anterior capsulorhexis, phacoaspiration, posterior capsulotomy and anterior vitrectomy, with implantation of a polymethyl methacrylate or hydrophobic acrylic IOL in the bag or the sulcus. The following data were analyzed: age at the time of surgery, type of cataract, associated abnormalities, complications, final anatomic and refractive status, final best-corrected visual acuity (BCVA).
The mean age at the time of surgery was 4.3±2.7 months. The morphology of cataract was total (45%), nuclear (42%), zonular (9%) and posterior subcapsular (6%). There was a family history of congenital cataract in 16 infants. Two infants suffered psychomotor delay. The most common postoperative complications were posterior proliferation, requiring anterior vitrectomy in 31% of the eyes, ocular hypertension (16%) and posterior synechia (14%). The final spherical equivalent refraction was -2.2±4.1 diopters (6.5±3.2 at 1 month postoperatively). After a mean follow-up of 3.7±1.5 years, final BCVA was as shown below.
Primary IOL implantation appears effective and safe in the management of bilateral congenital cataract in infants. Favorable visual outcomes can be achieved in the majority of cases. Opacification of the visual axis is the most common complication and the risk of glaucoma requires a careful long-term follow-up.
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