Visual outcomes and complications of cataract surgery with primary implantation in infants.
OBJECTIVE
To describe the visual results and postoperative complications of cataract surgery with primary intraocular lens (IOL) implantation performed in infants and to determine possible predictive factors related to poor visual outcome.


METHODS
A retrospective consecutive case series of cataract surgeries with primary IOL implantation in infants was performed. Visual outcome and postoperative complications were recorded. A final visual acuity>0.5 logMAR was considered as a poor visual outcome.


RESULTS
Sixty-one consecutive procedures were evaluated in 43 infants. Eighteen infants (42%) had bilateral cataract surgery and 25 (58%) had monocular surgery. The median age at primary surgery was 5.7 months (range: 4 weeks-24 months). The median follow-up was 47 months (range: 14-60 months). The median best-corrected visual acuity in logarithm of the minimum angle of resolution (logMAR) at the last follow-up examination was 1.00 in the case of unilateral surgery and 0.40 in the case of bilateral surgery. The overall visual result in all eyes was 0.50 logMAR. A better visual result was achieved when the infants were younger than 6 months or older than 12 months of age when surgery was performed. Opacification in the visual axis requiring secondary surgery occurred in 54% of the eyes (33/61). Postoperative inflammation occurred in 41% of the eyes (25/61) but was not associated with poor visual outcome (P=0.39). Glaucoma affected 11.5% of the eyes (7/61) and was significantly associated with poorer visual function (OR: 15.36, 95% CI 1.02-230.35, P=0.05). Compared with the unilateral cataract group, the OR of poor visual acuity was 0.06 (95% CI 0.01-0.35, P<0.01) in the bilateral cataract group. No statistical association was observed between final visual acuity>0.5 logMAR and leukocoria at time of diagnosis, IOL-related complications and postoperative strabismus.


CONCLUSIONS
Primary IOL implantation is associated with an overall satisfactory visual outcome, especially when surgery is performed before 6 months or after 12 months of age and in bilateral cases. Glaucoma is the main complication associated with poor visual outcome.
Service d'ophtalmologie, hôpital universitaire Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France. Electronic address: ophtalmo.vera@gmail.com.
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Vera
Unité d'épidémiologie clinique, hôpital Robert-Debré, AP-HP, Paris, France.
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Lambert
Unité d'épidémiologie clinique, hôpital Robert-Debré, AP-HP, Paris, France; UMR-S 1123 and CIC-EC 1426, ECEVE, université Paris Diderot, Sorbonne Paris Cité, Paris, France; U 1123 and CIC-EC 1426, ECEVE, INSERM, Paris, France.
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Sommet
Unité d'épidémiologie clinique, hôpital Robert-Debré, AP-HP, Paris, France; UMR-S 1123 and CIC-EC 1426, ECEVE, université Paris Diderot, Sorbonne Paris Cité, Paris, France; U 1123 and CIC-EC 1426, ECEVE, INSERM, Paris, France.
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Boulkedid
Unité d'épidémiologie clinique, hôpital Robert-Debré, AP-HP, Paris, France; UMR-S 1123 and CIC-EC 1426, ECEVE, université Paris Diderot, Sorbonne Paris Cité, Paris, France; U 1123 and CIC-EC 1426, ECEVE, INSERM, Paris, France.
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Alberti
Service d'ophtalmologie, hôpital universitaire Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
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Bui Quoc
D000367:Age Factors; D002387:Cataract Extraction / Q000009:adverse effects / Q000379:methods; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D019654:Lens Implantation, Intraocular / Q000009:adverse effects / Q000379:methods; D007910:Lenses, Intraocular / Q000009:adverse effects; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*
Acuité visuelle; Cataracte congénitale; Chirurgie; Complications; Congenital cataract; Implantation primaire; Primary IOL implantation; Surgery; Visual acuity