Type of intraocular lens used in pediatric cataract surgery determines opacification rates: Study

A research team led by Sebastian Küchlin, University of Freiburg, Freiburg, Germany, conducted the study to assess the period of secondary visual axis opacification (VAO) resulting in another surgery after implantation of a primary intraocular lens in children and further assessed surgical outcomes.

For this purpose, the researchers performed a single-center, retrospective analysis of children ages 1 to 14 who received cataract surgery with the implantation of primary IOL. The surgical procedure was either in-bag IOL placement with primary posterior capsulotomy and anterior vitrectomy or bag-in-lens IOL placement. Eyes with visually significant ocular comorbidities were excluded.

They analyzed medical records. The Kaplan–Meier method and a Cox proportional hazards model as used with predefined adjustments for the year of surgery, age at surgery, and the German Index of Socioeconomic Deprivation for analyzing VAO-free survival by lens type. To achieve longer follow-ups, patients were invited to attend a clinical visit. The overall median follow-up was 19 months.

The study's primary outcome was the survival rate without VAO that needed clearing of the visual axis following cataract surgery with primary IOL implantation.

The findings reported by the authors were as follows:

· 13 cases of VAO occurred at a median of 10 months after surgery. Of these, one eye had a 3-piece in-bag IOL, two eyes had bag-in-lens IOLs, and ten eyes had 1-piece in-bag IOLs.

· The adjusted hazard ratio for 1-piece acrylic IOLs was 32.8 and 19.6 for bag-in-lens IOLs, compared with 3-piece acrylic in-bag IOLs.

· Two eyes with bag-in-lens surgery (10%) had an iris capture.

· There was 1 case of endophthalmitis. No cases of postoperative retinal detachment or new glaucoma were found.

"Children with secondary VAO who needed a procedure to clear the visual axis generally presented within 15 months," the researchers wrote. "When a 3-piece acrylic IOL was used, opacification rates were lowest."

"Practitioners should be aware of the selection of lens types in cataract surgery among children to minimize the potential risk of visual impairment and amblyopia," they concluded.

Reference:

Küchlin S, Hartmann ES, Reich M, Bleul T, Böhringer D, Reinhard T, Lagrèze WA. Pediatric Cataract Surgery: Rate of Secondary Visual Axis Opacification Depending on Intraocular Lens Type. Ophthalmology. 2022 Sep;129(9):997-1003. doi: 10.1016/j.ophtha.2022.05.007. Epub 2022 May 17. PMID: 35595073.