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Scott R Lambert, George Cotsonis, Lindreth DuBois, Azhar Nizam, Carolyn Drews-Botsch; Visual outcomes at age 10.5 years in the Infant Aphakia Treatment Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3609.
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© ARVO (1962-2015); The Authors (2016-present)
Controversy exists regarding the implantation of an intraocular lens (IOL) during infancy after cataract surgery. In a randomized clinical trial we tested the hypothesis that visual acuity would be better after unilateral cataract surgery during infancy if an IOL was implanted compared to aphakia and contact lens (CL) correction.
Infants (n=114) <7 months of age with a unilateral congenital cataract were randomized to cataract surgery with (n=57) or without IOL implantation (n=57) in the Infant Aphakia Treatment Study (IATS). Eyes randomized to IOL implantation had their residual refractive error corrected with spectacles. Eyes randomized to no IOL had their refractive error initially corrected with a CL. Later, secondary IOLs were implanted in some of these eyes. Other patients who underwent large myopic shifts only wore a spectacle correction. Visual acuity was tested at age 10.5 years using the E-ETDRS testing protocol.
Visual acuity was tested in 99 patients (IOL group n=49; aphakia group n=50) at a mean age of 10.6 ± 0.28 years. The median logMAR acuity in treated eyes (IOL=0.88 (0.4,1.36); aphakia=0.86 (0.32,1.44); p=0.82) (Figures 1, 2) and untreated eyes (IOL=-0.02 (-0.08,0.08), aphakia=0.02: (-0.06,0.08); p=0.47) were similar in both treatment groups. In the IOL group the mean refractive error was -4.69 ± 7.04 D for treated eyes and 0.55 ± 3.22 D for untreated eyes. In the aphakia group, the mean refractive error for treated eyes that had undergone secondary IOL implantation (n=21) was -3.94 ± 3.27 D. For the remaining 30 patients, 18 were still wearing a CL (silicone elastomer n=6; rigid gas permeable n=6; hydrogel n=5; and silicone hydrogel n=1), 8 were wearing only spectacles and 4 no correction. The mean refractive error was lowest in the spectacles group (CL, +10.94 ± 4.66 D; Spectacles, +4.41 ± 3.76 D; none, +11.22 ± 6.64 D). The median logMAR acuity was best for children wearing a CL correction (CL, 0.37 (0.22,0.82); Spectacles, 1.42 (0.74,1.70); none, 1.60 (1.44,2.23); p=0.0046).
Visual outcomes were similar in the IATS at age 10.5 years for children randomized to primary IOL implantation or aphakia and CL correction. At age 10.5 years about one-third of patients in the aphakia group were still wearing a CL to correct their aphakia and they had the best visual outcomes..
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Histograms showing visual acuity (VA) at age 10.5 years for aphakia/CL and IOL treatment groups.
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