MULTIFOCAL IOLS

Multifocal IOL implantation appears to provide a safe and viable alternative to monofocal pseudophakia in selected paediatric cataract patients, according to a recent French study.

Addressing delegates attending the annual meeting of the French Implant and Refractive Surgery Association (SAFIR), Laurence Lesueur MD said that encouraging results had been obtained in a multicentre study of paediatric patients implanted with multifocal implants with up to six years of follow-up.

“The results of the SAFIR 2013 study confirm that hydrophobic multifocal IOLs in selected paediatric cataract patients are a good option if the indications are rigorously respected. The implants offer independence from glasses, limit amblyopia, assist binocular vision, especially in the younger patients, and improve the children’s quality of life without any significant complications to date,” she said.

Dr Lesueur, an ophthalmologist at Centre d’Ophtalmologie Jeanne d’Arc, Toulouse and CHU Toulouse Purpan, France, added, however, that careful monitoring of the IOL positioning is absolutely mandatory in the months and years after implantation.

“We would certainly advise caution in terms of monitoring the stability and centration of the implant over the long term and the patients and their guardians need to be informed of this issue prior to surgery,” she said. The indications for phaco-refractive surgery are very rare in children, said Dr Lesueur, with all aspects of the surgical process requiring care and attention.

“It is really the huge progress in adult phaco-refractive treatments and technologies in recent years that has enabled us to extend these treatments to selected paediatric cases, with the latest- generation multifocal implants giving us a chance to offer these children spectacle- free vision and an improved quality of life,” she said.

Dr Lesueur noted that the 2013 version of the study is really an updated and enhanced version of the initial trial of 24 eyes of 20 children that had been first presented in 2010, incorporating data from centres in Somain, Bordeaux, Paris, Marseille and Toulouse.

The latest data set presented by Dr Lesueur included 52 eyes of 41 children, with a maximum of six years of follow-up and a mean follow-up of 21 months. Patient ages ranged from nine months to 15 years, with an average of seven years. Of the 41 patients, 30 were treated for unilateral cataracts and 11 were bilateral cases.

Exclusion criteria are very important for paediatric patients, said Dr Lesueur, and need to be scrupulously adhered to. “We did not operate on any children with corneal anomalies, glaucoma, microphthalmia, pupillary deformation, retinopathies, neuro-ophthalmic anomalies or ocular inflammation,” she said.

In terms of surgical technique, 36 patients underwent straightforward phacoemulsification and multifocal IOL insertion, while 16 patients under the age of five had combined phacoemulsification, posterior capsulorhexis and anterior vitrectomy procedures.

A variety of multifocal IOLs including the AcrySof ReSTOR, AcrySof ReSTOR Toric, Tecnis ZM, Tecnis ZMT, NXG1, Acri.Lisa, and Acri.Lisa Toric were implanted through a 2.2mm to 3.2mm corneal incision.

Dr Lesueur said that the refractive results for the 41 eyes of 33 children with more than one year of follow-up were very good overall, with impressive outcomes for both uncorrected and corrected near and distance visual acuity specially in cases of unilateral cataract operated on after the age of six years.