Opacification of the visual axis after cataract surgery and single acrylic intraocular lens implantation in the first year of life.
OBJECTIVE
To report the incidence and risk factors for secondary surgical intervention to treat visual axis opacification (VAO) after cataract surgery and acrylic intraocular lens (IOL) implantation during the first year of life.


METHODS
A retrospective review of 29 eyes of 20 patients receiving a hydrophobic acrylic (AcrySof; Alcon, Fort Worth, TX) IOL implantation was conducted. All eyes underwent primary posterior capsulectomy and anterior vitrectomy. Statistical analysis was performed using SPSS for Windows (SPSS, Chicago, IL).


RESULTS
Average age at surgery was 4.8 +/- 3.7 months, and average follow-up was 33.4 +/- 16.1 months. Eleven of 29 (37.9%) eyes developed VAO requiring secondary surgical intervention at a median of 4.8 months (95% confidence interval 3.4 to 6.2). Average age at surgery for eyes that subsequently opacified was 3.8 +/- 3.0 months compared with 5.4 +/- 4.0 months for those whose visual axis remained clear (P = 0.26). The relative risk of subsequent VAO surgery was 2.7 for primary surgery performed at or before the first 6 months of life. Opacification was significantly related to eyes with associated ocular anomalies (eg, anterior segment dysgenesis, iris hypoplasia, or persistent fetal vasculature) with a relative risk of 8.6 (P < 0.001). Proliferation of cortex was the most common form of VAO, followed by mixed-type with predominantly fibrous, fibrous alone, or Elschnig pearls. When secondary surgery was required, it occurred primarily during the first 6 months (ie, 9 of 11 patients) after the initial cataract surgery.


CONCLUSIONS
When cataract and IOL surgery was undertaken within the first year of life, a secondary surgical procedure was required in 37.9% of eyes to maintain a clear visual axis. Most secondary surgery for VAO occurred within the first 6 months after surgery. Postoperative opacification was most common in eyes with associated ocular anomalies.
Trivedi
Rupal H
RH
Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, 167 Ashley Avenue, Charleston, SC 29425-5536, USA.
Wilson
M Edward
ME
Bartholomew
Luanna R
LR
Lal
Garima
G
Peterseim
M Millicent
MM
D000179:Acrylates; D002387:Cataract Extraction / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular / Q000009:adverse effects; D008297:Male; D012086:Reoperation; D014786:Vision Disorders / Q000209:etiology* / Q000601:surgery; D014792:Visual Acuity
D000179:Acrylates