IOL implantation in infants less than six months of age with congenital cataracts can be safe, cost-effective and as easily managed over the long term. This approach compares favourably with an aphakia with contact lenses approach, although each eye and each patient are different and socioeconomic factors must also be taken into consideration, said Ramesh Kekunnaya FRCS, Head, Child Sight Institute, LV Prasad Eye Institute Hyderabad, India.
Speaking at the World Society of Paediatric Ophthalmology and Strabismus (WSPOS) Subspecialty Day in Paris during the 37th Congress of the ESCRS in France, Dr Kekunnaya noted that in the multi-centre randomised controlled Infant Aphakia Treatment Study (IATS), eyes that underwent IOL implantation had significantly higher rates of intraoperative complications (28% vs. 11%; p=0.031), adverse events (77% vs. 25%; p<0.0001), and additional intraocular reoperations (63% vs. 12%; p<0.0001) during the first postoperative year than those who remained aphakic and received contact lenses. All the above infants had unilateral congenital cataract.
On the other hand, there was no significant difference between the groups in terms of visual outcome (Plager et al,
Ophthalmology. 2011 Dec;118(12):2330-4).
In the IOL group, iris prolapse was the most common intraoperative complication. Visual axis opacification was the most common adverse event, occurred in 69% of eyes. Clearing of visual axis opacification was the most common additional intraocular reoperation. Glaucoma occurred in 12% of eyes.
A study conducted in LVPEI, Hyderabad, India, supported the efficacy of IOLs in bilateral congenital cataract cases but also showed that postoperative complication rates may
not always be as high as in the IATS study. The series included 69 eyes of 38 infants with a mean age of 4.6 months After a mean follow-up of 51 months (range: 36-84), the median best-corrected visual acuity was 0.74 logMAR in eyes with bilateral cataracts and 0.87 logMAR in eyes with unilateral cataracts.
He noted that there were no postoperative complications in 70% of patients. The most common postoperative complication was visual axis opacification necessitating membranectomy in 13 eyes, (18%), followed by pigmentary IOL deposits (11 eyes, 15%) and IOL decentration and glaucoma in four eyes each (5.6%).
In the IATS study, the total cost of management was calculated to be around 5% higher in the lOL group compared to the contact lens group, which was mainly attributable to the higher number of unplanned surgeries in the IOL group. However, cost estimates vary considerably internationally and can be much more favourable for IOL implantation in lower income countries.
Ramesh Kekunnaya: rameshak@lvpei.org
