Primary Intraocular Lens Insertion in Infants Under 6 Months of Age: A Retrospective Cohort Study.

BACKGROUND/AIMS: Pediatric cataracts are considered a leading cause of visual impairment. While intraocular lens (IOL) implantation is mostly performed for children >2 years, its use in younger children remains contentious. This study assessed primary IOL in a unique pediatric population characterized by limited adherence to postoperative care, where primary IOL implantation was favored to minimize the risk of prolonged uncorrected aphakia.

METHODS

This retrospective study examined primary IOL implantation outcomes in children across three age brackets: below 6 months, 6-12 months, and 1-18 years, focusing on best-corrected visual acuity (BCVA) and complications including glaucoma, toxic anterior segment syndrome (TASS), retinal detachment (RD), and yttrium-aluminum-garnet (YAG)/membranectomy.

RESULTS

169 eyes from 119 patients were evaluated over a median follow-up period of 6.4 years. No significant differences were observed between age groups in terms of LogMAR visual acuity (p = 0.344) or the incidence of postoperative complications such as glaucoma (p = 0.244), retinal detachment (p = 0.244), or TASS (p = 0.960). The incidence of YAG capsulotomy/membranectomy was highest in the <6 months group (36%), compared to 22% in the 6-12 months group and 13% in the >1 year group (p = 0.020). Among unilateral cases, all 3 patients diagnosed before 6 months required YAG/membranectomy.

CONCLUSION

Primary IOL implantation for pediatric cataracts resulted in comparable visual acuity and overall complication rates across all age groups. Although a higher incidence of YAG/membranectomy was observed in children under 6 months, particularly among unilateral cases, most patients still avoided the need for additional surgical intervention. These findings support primary IOL implantation as a valid option for selected patients.