gms | German Medical Science

The optimal role of intraocular lenses (IOLs) in infants remains a controversial topic. Some ophthalmologists advocate correction with a contact lens (CL), whereas others recomended an intraocular lens (IOL) correction. Our study compared visual acuity, ocular alignment, retreatment rate and binocular vision outcomes in our pediatric patients.

This study included 49 children with a unilateral congenital cataract who had cataract surgery with posterior capsulorhexis and anterior vitrectomy, coupled with (IOL group, n=21) primary IOL implantation or without (CL group, n=28). All infants undergone the first surgery during 12 months of their life and they were operated in the period from 1994 to 2000. The mean age at surgery was 3.11±2.65 months (range: 28 days to 11 months. All patients were prescribed the same half-time reduced occlusion therapy. Good parents cooperation and good compliance with patching were the necessary conditions to include a patients into the study. In the period from January 2004 to February 2006, the final visual acuity and binocular vision outcomes were examined.

The mean final visual acuity (LogMAR) for the operated eye was 0.43±0.33 for the IOL group and 0.58±0.39 for the CL group (P=0.14). The mean interocular difference in visual acuity was 0.22±0.29 for the IOL group and 0.56±0.31 for the CL group (P=0.042). The reoperation rate was 78% in the IOL group compared with 35% in the CL group (P=.017). Esotropia or exotropia more than 8 prism diopters (PD) were present at 55% of children (10 from 18) in the IOL group compared with 83% of children (19 from 23) in the CL group (P=0.039).

We suggest that correction of aphakia after unilateral congenital cataract surgery with primary IOL implantation results in an improved visual acuity, binocular vision outcome and less occurence of strabismus, but a higher rate of complications requiring reoperation. Further studies with a larger pediatric patients are suitable to confirm the optimal treatment for aphakia after unilateral congenital cataract extraction.