Source: DGNews  |  Posted 1 year ago

CHICAGO -- May 10, 2010 -- Among infants who undergo surgery to treat congenital cataract, surgical lens replacement appears to cause more complications while achieving the same treatment benefit as treatment with contact lenses, according to a study published early online and appearing in the July print issue of Archives of Ophthalmology.

Since the 1970s, contact lenses have been the standard way of treating aphakia, according to background information in the article. "Their use during infancy, however, can be challenging owing to problems with insertion and removal of lenses by parents, lens loss, difficulties with fitting the steep corneas of infants and compliance problems," the authors wrote. "These factors among others probably contribute to the poor visual outcome of many children with unilateral aphakia."

In recent years, the technology to surgically implant a lens directly into the eye has improved considerably, the authors noted. Scott R. Lambert, MD, Emory Eye Center, Atlanta, Georgia, and colleagues compared visual outcomes and adverse events among 114 infants (median age at surgery, 1.8 months) randomly assigned to receive either an intraocular lens or contact lens after cataract surgery.

The rate of complications during surgery was 16 of 57 (28%) in the intraocular lens group and 6 of 57 (11%) in the contact lens group. At age 1 year, visual acuity results did not differ between the 2 groups. However, more adverse events had occurred among children with intraocular lenses (77% vs 25%), and these children were also 5 times more likely to undergo additional intraocular operations (63% vs 12%).

"Thus, there appears to be no short-term visual benefit and some increased risk to implanting intraocular lenses in infants," the authors wrote. "However, since there remains a possibility that intraocular lenses may be found to be beneficial after a longer follow-up, we feel it would be premature to recommend that intraocular lenses not be implanted in infants."

"We suggest that practitioners continue to exercise caution when considering implanting intraocular lenses in infants," they concluded. "The ultimate role for intraocular lens implantation during infancy may be further clarified after a longer follow-up with these children."

SOURCE: Archives of Ophthalmology