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Carolyn Drews-Botsch, Azhar Nizam, Edward Wilson, Deborah Vanderveen, Scott R Lambert; Secondary IOL Implantation among aphakic children in the Infant Aphakia Treatment Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3135. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Implanting an intraocular lens (IOL) at the time of cataract extraction is not standard of care for infants with unilateral congenital cataract (UCC). This analysis examines secondary IOL implantation between age 5 and 10½ years. We hypothesized that most aphakic patients would elect to have IOL implantation, and implantation would be associated with visual acuity (VA) and adherence to contact lens wear.
The Infant Aphakia Treatment Study (IATS) is a randomized controlled trial of initial treatment for UCC. Participants randomized to standard treatment were left aphakic until age 5 unless poor adherence to contact lens use threatened vision, and then only with the approval of the IATS Steering Committee. After age 5, secondary IOL implantation was left to the discretion of the surgeon and the family. Secondary IOL implantation was assessed at age 10 1/2 years through medical record review.
53 children who were randomized to be left aphakic were followed at age 10 ½ years of age; 22 of these (42%) had received a secondary IOL. The Steering Committee approved secondary IOL implantation prior to age 5 in 3 patients (6%), and these are excluded from subsequent analyses. All 9 patients at one site received a secondary IOL; 7 (78%) before 6½. Another received an IOL at 6.6 years. At the remaining sites, 10 of 41 aphakic children (24%) received secondary IOLs; 7 (70%) before age 6½. At sites where secondary IOL implantation was not routine, visual acuity at age 4½ years was not associated with secondary IOL implantation (3 of 12 patients (25%) with visual acuity (VA) better than 20/40; 2 of 10 patients (20%) with VA 20/40 to < 20/200; and 5 of 19 patients (26%) with VA 20/200 or worse) (Fisher’s exact test p=1.0) None of the 5 children who reported wearing a contact lens less than half of waking hours when 4 years of age received a secondary IOL; 31% (8 of 26, Fisher’s Exact test p=0.3) of those reporting more contact lens use received a secondary IOL.
There is variation among centers and families regarding elective secondary IOL implantation for children with a UCC who are initially left aphakic, and neither visual acuity nor adherence to CL wear appear to be driving this choice. Since children who are 5 years of age are in the typical age for IOL implantation, many families chose to proceed soon after they became eligible.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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