Complications, Visual Acuity, and Refractive Error Three Years After Secondary Intraocular Lens implantation for Pediatric Aphakia

Serena Wang; Michael X Repka; Desirae R Sutherland; Sarah R Hatt; Elias I Traboulsi; Scott R Lambert; B Michele Melia; Raymond T Kraker; Jonathan M Holmes; Susan A Cotter; Pediatric Eye Disease Investigator Group

doi:10.1016/j.ophtha.2024.05.011

Complications, Visual Acuity, and Refractive Error Three Years After Secondary Intraocular Lens implantation for Pediatric Aphakia

Ophthalmology. 2024 May 14:S0161-6420(24)00301-4. doi: 10.1016/j.ophtha.2024.05.011. Online ahead of print.

Affiliations

¹ University of TexasSouthwestern Medical Center, Dallas, TX. Electronic address: pedig@jaeb.org.
² Wilmer Eye Institute, Baltimore, MD.
³ Jaeb Center for Health Research, Tampa, FL.
⁴ Mayo Clinic, Rochester, MN.
⁵ Cole Eye Institute, Cleveland, OH.
⁶ Stanford University, Palo Alto, CA.
⁷ University of Arizona- Tucson, Tucson, AZ.
⁸ Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, CA.

PMID: 38754556
DOI: 10.1016/j.ophtha.2024.05.011

Abstract

Objective: To report the cumulative incidence of complications and describe refractive error and visual acuity (VA) outcomes in children undergoing secondary intraocular lens (IOL) implantation following previous surgery for non-traumatic cataract.

Design: Pediatric cataract registry.

Participants: 80 children (108 eyes: 60 bilateral, 48 unilateral) undergoing lensectomy at <13 years of age, followed by secondary IOL implantation at median age (range) of 2.7 (0.6 to 5.0) years for bilateral and 2.1 (0.5 to 6.4) for unilateral cases.

Methods: Annual data collection from medical record review through 5 years following lensectomy.

Main outcome measures: Cumulative incidence of newly emergent complications following secondary IOL implantation; refractive error and VA by 5 years after lensectomy.

Results: Median (interquartile range [IQR]) follow-up following secondary IOL implantation was 2.5 years (0.8 to 3.3 years). A common complication following secondary IOL implantation was a glaucoma-related adverse event (GRAE: glaucoma or glaucoma suspect); the cumulative incidence was 17% (95% CI: 3%-29%) in bilateral and 12% (95% CI: 0%-23%) in unilateral cases. The cumulative incidence of surgery for visual axis opacification was 2% (95% CI: 0%-7%) for bilateral and 4% (95% CI: 0%-10%) for unilateral cases. Median prediction error (IQR) within 90 days of implantation was 0.88 D (-0.50 D to +3.00 D) less hyperopic than intended among 21 eyes for bilateral cases and 1.50 D (-0.25 D to +2.38 D) less among 19 unilateral cases. Median (IQR) spherical equivalent refractive error at 5 years (median 5.1 years of age) in eyes receiving a secondary IOL was +0.50 D (-2.38 D to +2.94 D) for 48 bilateral and +0.06 D (-2.25 D to +0.75 D) for 22 unilateral cases. Median (IQR) monocular VA at 5 years was 20/63 (20/50-20/100) for bilateral (n=42) and 20/400 (20/160-20/800) for unilateral (n=33) cases.

Conclusions: Eyes with secondary IOL implantation have an ongoing risk of new glaucoma-related adverse events. Five years after lensectomy (approximately 2.5 years after secondary IOL implantation), average refractive error was less hyperopic than desired given the anticipated further myopic shift before refraction stabilizes.