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Secondary intraocular lens implantation may worsen IOP control in kids: Study
Recently, researchers have noted that secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk, according to a study published in the Eye Journal.
In recent years primary IOL implantation is fast becoming the preferred modality of treatment for most children older than two years of age. It has been extensively used with favorable results in children older than two years. In contrast, IOL implantation as a modality of aphakic correction in an infantile eye is debatable. Prime among the problems of primary IOL implantation in infants includes difficulty in selecting the appropriate diopteric power of the IOL. In addition, the small dimension of the infant's eye with a small capsular bag, decreased scleral rigidity, and increased tissue reactivity leading to excessive postoperative inflammation, make IOL implantation technically more difficult in these patients.
Hence, Peter J Ness and colleagues from the Medical University of South Carolina carried out this study to compare intraocular pressure (IOP) control before and during the first year after secondary intraocular lens (IOL) implantation in children. The authors conducted a retrospective chart review of children who received secondary IOL implantation. A total of 100 eyes were included. The mean duration of follow-up was 7.74 months (SD = 3.11). IOP and antiglaucoma medications before and after implantation were analyzed. The latest exam with IOP measurement found within the 2-15 month period after IOL implantation was used for the postoperative data. Failure to maintain IOP control was defined as either the addition of antiglaucoma medication(s) or a rise in IOP > 4 mm Hg. Statistical analyses were performed to assess risk factors for failure to control IOP after surgery, namely age at IOL implantation, preoperative glaucoma status, and IOL fixation location. The following findings were drawn- a. Twenty-three of one hundred eyes failed to maintain IOP control according to our definition. b. Eyes with a history of having had a traumatic cataract (n = 3) had a more than threefold increased risk of failure (P = 0.015). c. Although not statistically significant, very young age at initial cataract surgery (<2 months old) had a twofold increased risk of failure compared to an older age (>12 months old) (P = 0.213). d. No other risk factors were found to have statistical significance. Therefore, it was concluded that "secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk."
The following findings were drawn- a. Twenty-three of one hundred eyes failed to maintain IOP control according to our definition. b. Eyes with a history of having had a traumatic cataract (n = 3) had a more than threefold increased risk of failure (P = 0.015). c. Although not statistically significant, very young age at initial cataract surgery (<2 months old) had a twofold increased risk of failure compared to an older age (>12 months old) (P = 0.213). d. No other risk factors were found to have statistical significance. Therefore, it was concluded that "secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk."
b. Eyes with a history of having had a traumatic cataract (n = 3) had a more than threefold increased risk of failure (P = 0.015). c. Although not statistically significant, very young age at initial cataract surgery (<2 months old) had a twofold increased risk of failure compared to an older age (>12 months old) (P = 0.213). d. No other risk factors were found to have statistical significance. Therefore, it was concluded that "secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk."
d. No other risk factors were found to have statistical significance. Therefore, it was concluded that "secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk."
BDS, MDS( Pedodontics and Preventive Dentistry)
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751