Major article
Visual Acuity Development After the Implantation of Unilateral Intraocular Lenses in Infants and Young Children

Presented at the annual meeting of AAPOS in Orlando, Florida, 2005.
https://doi.org/10.1016/j.jaapos.2005.07.008Get rights and content

Purpose: Intraocular lenses (IOLs) are now being implanted in infants and children with unilateral cataracts. However, there are no prospective data on the development of visual acuity after implantation. The aim of the present study was to prospectively assess the development of acuity in infants and preschool children who received IOLs or aphakic contacts lenses (CLs) after the extraction of a unilateral cataract. Methods: Visual acuity was assessed using Teller Acuity Cards and/or crowded HOTV tests at target ages of 6 months, 1, 2, 3, and 4 years. Results: Infants who received a primary IOL after extraction of dense congenital unilateral cataract (n = 5) showed improvement from an initially low mean visual acuity of 20/170 at 6 months to 20/85 at 12 months and 20/54 at 4 years. Visual acuity in the IOL group was similar to that of children who had good-to-excellent compliance with CL wear (n = 36; 4-year visual acuity 20/50) and better than that of children who had moderate-to-poor compliance (n = 11; 4-year visual acuity 20/135). Children who received IOLs after extraction of developmental unilateral cataracts by 6 months (n = 4; 4-year visual acuity 20/55) had visual acuity development similar to those treated with CLs (n = 5; 4-year visual acuity 20/55). Children who received IOLs after extraction of developmental unilateral cataracts after 1 year of age (n = 18) had better visual acuity than children those treated with CLs (n = 4) at 4 years of age (20/40 vs. 20/135). Conclusion: IOLs and aphakic CLs support similar visual acuity development after surgery for a unilateral cataract. IOLs may support better visual acuity development when compliance with CL wear is moderate to poor or when a cataract is extracted after 1 year of age.

Section snippets

Participants

Participants included 71 infants who were diagnosed with a unilateral dense congenital cataract during the first 2 weeks of life, of whom 5 received a primary IOL and 66 were fitted with an aphakic contact lens after cataract extraction. Of the 66 who received an aphakic contact lens, 15 had an IOL implanted as a secondary procedure at a later date. In addition, 31 children with developmental cataracts participated, of whom 9 developed dense cataracts during infancy and had surgery by 6 months

Primary IOLs for Unilateral Dense Congenital Cataracts

Visual acuity maturation for pseudophakic and fellow eyes of infants who received a primary IOL after extraction of a unilateral dense congenital cataract at 3.8 ± 3.1 month of age is shown in Figure 1. At 6 months of age, the mean pseudophakic eye visual acuity was 0.925 logMAR (20/170). Visual acuity in the pseudophakic eye improved rapidly to 0.628 logMAR (20/85) by 1 year of age, when it approached the visual acuity of the fellow eye (0.530 logMAR, 20/70). After 1 year of age, visual acuity

Discussion

IOLs and aphakic contact lenses support similar visual acuity development in infants and young children treated for unilateral dense congenital cataracts. Contact lenses are the most common mode of aphakic optical correction in infants because they generally are well tolerated and because the power of the aphakic contact lens can be changed frequently to keep pace with the rapidly changing refractive error of the maturing aphakic eye. The data presented here suggest that IOLs, used in

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    Supported by a grant from the National Eye Institute (EY05236) and a Fight for Sight Summer Internship (SF04045).

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