Among infants whose lenses are surgically replaced during management of congenital cataract, lens implantation may cause more complications than contact lens usage while offering the same treatment benefits, according to an online article in Archives of Ophthalmology.
Researchers compared visual outcomes and adverse events among 114 infants assigned to receive either an IOL or contact lens after cataract surgery. Within a week of cataract removal, patients in the contact lens group were fitted with a soft lens or a gas-permeable lens, and the lens was to be worn at all times when the patient was awake.
Parents of patients in both groups followed a patching regimen until the infant reached the age of eight months. At that point, patching was prescribed for all waking hours on alternate days.
During surgery, 28% of IOL patients experienced one or more complications vs. 11% in the contact lens group. This difference was due primarily to a higher incidence of iris prolapse in the IOL group, researchers note. Prolapse occured in 21% of eyes in the IOL group vs. only 2% in the contact lens group.
At age one, visual acuity results did not differ between the two groups, but more adverse events had occurred among children with IOLs—77% vs. 25%. The most common complications in the IOL group were lens reproliferation into the visual axis, pupillary membranes and corectopia. In the contact lens group, common complications included presumed bacterial keratitis, corneal abrasion, corneal opacity, Haemophilus influenzae and retinal detachment.
“Our results demonstrate no visual acuity benefit at age one year for primary IOL implantation and an increased incidence of complications requiring additional surgical interventions in the IOL group,” write the researchers. “These findings are not entirely unexpected.”
The authors hypothesize that any possible benefit of IOL implantation may present as the child matures. “We anticipate that the real benefit of IOL implantation may occur later, especially if children in the contact lens group become less compliant with contact lens use as they become older. If this is true, it is possible that the children in the IOL group will have an increasing visual advantage with their pseudophakic correction alone as they become older and approach emmetropia.”
The researchers plan to follow up with the children at age four to determine further visual progress.
Lambert SR, Buckley EG, Drews-Botsch C, et al. The Infant Aphakia Treatment Study Group. A randomized clinical trial comparing contact lens with intraocular lens correction of monocular aphakia during infancy: grating acuity and adverse events at age 1 year. Arch Ophthalmol. 2010;128(7): [e-pub ahead of print]