A comparison of grating visual acuity, strabismus, and reoperation outcomes among children with aphakia and pseudophakia after unilateral cataract surgery during the first six months of life.
OBJECTIVE
The method of correcting aphakia after unilateral cataract extraction during infancy is controversial. Some authorities advocate correction with an intraocular lens (IOL) whereas others advocate correction with a contact lens (CL). We compared grating visual acuity, alignment, and reoperative outcomes in age-matched children treated with these 2 modalities at 5 clinical centers.


METHODS
Twenty-five infants born in 1997 or 1998 with a dense unilateral congenital cataract who had cataract surgery coupled with (IOL group, n = 12) or without (CL group, n = 13) primary IOL implantation were enrolled in this study. All patients were prescribed half-time occlusion therapy. In July 1999, their grating visual acuities, ocular alignments, and reoperation rates were assessed.


RESULTS
The mean grating visual acuity (LogMAR) for the affected eye was 0.70 +/- 0.32 for the IOL group and 0.87 +/- 0.31 for the CL group (P =.19). The mean interocular difference in grating visual acuity was 0.26 +/- 0.30 for the IOL group and 0.50 +/- 0.28 for the CL group (P =.048). The incidence of strabismus (>10 PD) was 75% in the IOL group compared with 92% in the CL group (P =.24). The incidence of reoperations was 83% in the IOL group compared with 23% in the CL group (P =.003).


CONCLUSIONS
Our preliminary data suggest that correcting aphakia after unilateral congenital cataract surgery with primary IOL implantation results in an improved visual outcome but a higher rate of complications requiring reoperation. A randomized clinical trial, the Infant Aphakia Treatment Study, is planned to further study the optimal treatment for aphakia following unilateral cataract extraction during infancy.
Lambert
S R
SR
Emory Eye Center, Atlanta, Georgia 30322, USA.
Lynn
M
M
Drews-Botsch
C
C
Loupe
D
D
Plager
D A
DA
Medow
N B
NB
Wilson
M E
ME
Buckley
E G
EG
Drack
A V
AV
Fawcett
S L
SL
D001036:Aphakia, Postcataract / Q000503:physiopathology* / Q000628:therapy; D002386:Cataract / Q000151:congenital; D002387:Cataract Extraction; D003261:Contact Lenses; D006801:Humans; D015994:Incidence; D007223:Infant; D019654:Lens Implantation, Intraocular; D019591:Pseudophakia / Q000503:physiopathology* / Q000628:therapy; D012086:Reoperation; D012683:Sensory Deprivation; D013285:Strabismus / Q000209:etiology / Q000503:physiopathology*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology