Surgical outcomes of primary foldable intraocular lens implantation in children: understanding posterior opacification and the absence of glaucoma.

PURPOSE: To evaluate visual and stereoscopic performance after pediatric cataract extraction with intraocular lens (IOL) implantation performed by the same surgeon over 24 years and to review the complications.

SETTING

The Alberta Children's Hospital, Calgary, Alberta, Canada.

METHODS

This retrospective review comprised children aged 1 month to 18 years who had small-incision cataract extraction with foldable posterior chamber IOL implantation from 1995 to 2008.

RESULTS

The postoperative follow-up was 6 months to 12 years. Posterior capsule opacification (PCO) requiring secondary surgical membranectomy developed in 22.7% of the children. Younger children developed PCO more often than older children. The PCO rate was 70.8% in children younger than 1 year and decreased steadily to 6.1% in children older than 7 years. The mean onset of PCO was 6.1 months postoperatively. Other complications were vitreous tags (12.0%), IOL dislocation (4.7%), and loose corneal sclera sutures (2.7%). Of the eyes in which vision could be recorded, 89.5% had improved corrected visual acuity, with no eye losing acuity. Stereopsis was present in 35% of testable children preoperatively and 91% postoperatively.

CONCLUSIONS

Cataract surgery in children younger than 2 years should be considered a 2-stage procedure in view of the higher incidence of PCO. Secondary glaucoma decreased significantly when surgery was performed after 30 days of age and the eye was left pseudophakic after surgery. Further improvements in IOL design, surgical instrumentation, and implantation techniques will continue to improve the ability to visually rehabilitate children.