Recent study shows intraocular lenses not the best treatment option for aphakic babies
About four years ago I published a blog discussing the relative merits of contact lenses or intraocular lenses for unilateral aphakic babies. This blog was based on a paper in the Journal of the American Medical Association (JAMA) Ophthalmology which compared the visual outcomes of unilateral aphakic babies optically corrected with contact lenses versus intraocular lenses (IOLs) following unilateral cataract surgery during early infancy. The study also looked at the efficacy and safety of primary IOL implantation for infantile unilateral aphakia. With respect to the visual outcomes, there was no significant difference between the visual acuity of children who underwent primary IOL implantation and those who were fitted with contact lenses. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. Based on these findings, the authors recommended that for infants with unilateral cataract the best option was generally to leave the eye aphakic and use a contact lens – rather than an IOL – for vision correction.
The results of a recent study published in a paper in the esteemed journal Lancet Child and Adolescent Health strongly support the findings of this earlier paper. This new study looked at five-year outcomes after primary IOL implantation in children aged two years or younger with congenital cataract. The findings of this study showed that IOL implantation – when compared to contact lens correction – did not confer better vision or protection against post-operative glaucoma and conversely it increased the risk of requiring early reoperation in children younger than two years with bilateral or unilateral cataract. Based on these results, the authors of this paper concluded that the routine use of IOL implantation in this age group could not be recommended.