Complications, Visual Acuity, and Refractive Error 3 Years after Secondary Intraocular Lens Implantation for Pediatric Aphakia

Abstract

Purpose: To report the cumulative incidence of complications and to describe refractive error and visual acuity (VA) outcomes in children undergoing secondary intraocular lens (IOL) implantation after previous surgery for nontraumatic cataract.

Design: Pediatric cataract registry.

Participants: Eighty children (108 eyes: 60 bilateral, 48 unilateral) undergoing lensectomy at younger than 13 years of age.

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

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

Results: Median follow-up after secondary IOL implantation was 2.7 years (interquartile range [IQR], 0.8-3.3 years; range, 0.6-5.0 years) for bilateral and 2.1 years (range, 0.5-6.4 years) for unilateral cases. A common complication after secondary IOL implantation was a glaucoma-related adverse event (GRAE; glaucoma or glaucoma suspect); the cumulative incidence was 17% (95% confidence interval [CI], 3%-29%) in bilateral cases 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 cases and 4% (95% CI, 0%-10%) for unilateral cases. The median prediction error within 90 days of implantation was 0.88 diopter (D; IQR, -0.50 to +3.00 D) less hyperopic than intended among 21 eyes for bilateral cases and 1.50 D (IQR, -0.25 to +2.38 D) less among 19 unilateral cases. The median spherical equivalent refractive error at 5 years (at a median of 5.1 years of age) in eyes receiving a secondary IOL was +0.50 D (IQR, -2.38 to +2.94 D) for 48 bilateral cases and +0.06 D (IQR, -2.25 to +0.75 D) for 22 unilateral cases. Median monocular VA at 5 years was 20/63 (IQR, 20/50-20/100) for bilateral cases (n = 42) and 20/400 (IQR, 20/160-20/800) for unilateral cases (n = 33).

Conclusions: Eyes with secondary IOL implantation have a risk of developing new GRAEs. Five years after lensectomy (approximately 2.5 years after secondary IOL implantation), the average refractive error was less hyperopic than desired given the anticipated further myopic shift before refraction stabilizes.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Aphakia; Intraocular lenses; Pediatric cataract.

Figure 1.

The 3-year estimated cumulative incidence of glaucoma-related adverse events (GRAE) following secondary IOL surgery is depicted in a Kaplan-Meier plot, adjusted for nonindependence of eye pairs. Estimates and 95% confidence intervals (CI) are provided, stratified by laterality of the surgery. The risk of GRAE was similar in eyes with bilateral and unilateral secondary IOL surgery (HR = 1.72, 95% CI: 0.54-6.44, p=.44). The number of eyes that were at risk and the number of reported GRAE by the given visit year are indicated above the figure.

Figure 2.

The 5-year estimated cumulative incidence of glaucoma-related adverse events (GRAE) after lensectomy is depicted in a Kaplan-Meier plot, adjusted for nonindependence of eye pairs. Estimates and 95% confidence intervals (CI) are provided, stratified by laterality and whether a secondary IOL was implanted in a subsequent surgery. The 5-year risk of GRAE was similar when comparing eyes that received a secondary IOL and those that did not, within subgroups of bilateral lensectomy (HR = 1.36, 95% CI: 0.82-2.39, p=.35) and unilateral lensectomy (HR = 1.78, 95% CI: 0.78-4.80 , p=.18). The number of eyes that were at risk and the number of reported GRAE by the given visit year are indicated above the figure.

Figure 3.

The boxplot represents the distribution of the 5-year spherical equivalent refractive error in eyes with bilateral or unilateral secondary IOL surgery. The sample size for the groups is provided below each respective box and the median refractive error is given in diopters (D).

Figure 4.

The boxplot represents the distribution of the 5-year visual acuity in eyes with bilateral or unilateral secondary IOL surgery. The sample size for the groups is provided below each respective box and the median visual acuity is given in both Snellen and logMAR values.