title: Risks and outcomes associated with primary intraocular lens implantation in children under 2 years of age: the IoLunder2 cohort study.
abstract: OBJECTIVE
  To investigate outcomes following cataract surgery with and without primary intraocular lens (IoL) implantation in children under 2 years of age with congenital or infantile cataract.
  
  
  METHODS
  Prospective population based cohort study undertaken through the British Isles Congenital Cataract Interest Group, with systematic data collection on children undergoing surgery in UK and Ireland between January 2009 and December 2010. ORs for the association between IoL implantation and visual acuity, postoperative glaucoma and reoperation at 1 year after surgery were estimated using multivariable regression analysis to control for potential confounders.
  
  
  RESULTS
  Of 221 children, 56/131 with bilateral and 48/90 with unilateral cataract underwent primary IoL implantation. IoL implantation was independently associated with better visual outcome in bilateral (OR 4.6, 95% CI 1.6 to 13.1, p=0.004) but not unilateral disease. IoL use increased the odds of reoperation requiring repeat general anaesthetic (bilateral OR 5.5, p<0.01; unilateral OR 16.7, p<0.01). IoL implantation did not reduce the odds of postoperative glaucoma.
  
  
  CONCLUSIONS
  The use of IoLs in cataract surgery in young children should be critically reassessed, particularly used in settings/communities where close, long-term follow-up is challenging. The absence of visual benefit and the lack of a previously postulated protective effect against postoperative glaucoma serve to question the value of IoLs in unilateral disease. The potential association between IoL use and better early visual outcomes in bilateral disease needs to be balanced against the risk of reoperation and exposure to additional general anaesthetics during a key period of neurodevelopment.
authors.affiliation: Life Course Epidemiology and Biostatistics Section, University College London Institute of Child Health, London, UK NIHR Moorfields Biomedical Research Centre / Institute of Ophthalmology, University College London, London, UK Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, UK.
authors.forename: Ameenat Lola
authors.initials: AL
authors.lastname: Solebo
authors.affiliation: Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, UK Great Ormond Street Hospital for Children, London, UK.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Russell-Eggitt
authors.affiliation: Life Course Epidemiology and Biostatistics Section, University College London Institute of Child Health, London, UK Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, UK.
authors.forename: Phillippa M
authors.initials: PM
authors.lastname: Cumberland
authors.affiliation: Life Course Epidemiology and Biostatistics Section, University College London Institute of Child Health, London, UK NIHR Moorfields Biomedical Research Centre / Institute of Ophthalmology, University College London, London, UK Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, UK Great Ormond Street Hospital for Children, London, UK.
authors.forename: Jugnoo S
authors.initials: JS
authors.lastname: Rahi
mesh_terms: D002386:Cataract / Q000151:congenital; D002387:Cataract Extraction; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D019654:Lens Implantation, Intraocular; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D019591:Pseudophakia / Q000503:physiopathology*; D012086:Reoperation; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology*
keywords: Child health (paediatrics); Epidemiology; Lens and zonules; Treatment Surgery