Objective-To compare the visual outcomes and adverse events of contact lens to primary intraocular lens (IOL) correction of monocular aphakia during infancy.Methods-In a randomized, multicenter (12 sites) clinical trial, 114 infants with a unilateral congenital cataract were assigned to undergo cataract surgery between 1 to 6 months of age either with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Grating visual acuity was tested at 1 year of age by a masked traveling examiner Main Outcome Measures-Grating visual acuity at 1 year of age.Results-The median logMAR visual acuity was not significantly different between the treated eyes in the two groups (CL = 0.80, IOL = 0.97, p =.20). More patients in the IOL group underwent one or more additional intraocular surgeries than patients in the CL group (63% vs 12%; p <. 0001). Most of these additional surgeries were performed to clear lens reproliferation and pupillary membranes from the visual axis.Conclusions-There was no statistically significant difference in grating visual acuity at age 1 year between the IOL and CL groups; however, additional intraocular surgeries were performed more frequently in the IOL group.Application to Clinical Practice-Until longer term follow-up data are available, caution should be exercised when performing IOL implantation in children 6 months of age or younger given the higher incidence of adverse events and the absence of an improved short-term visual outcome compared to contact lens use.

Purpose: To analyze and compare retreatment rates after wavefront-optimized photorefractive keratectomy (PRK) and LASIK and determine risk factors for retreatment. Methods: A retrospective chart review was performed to identify patients undergoing PRK or LASIK with the wavefront-optimized WaveLight platform from January 2005 through December 2006 targeted for a plano outcome and to determine the rate and risk factors for retreatment surgery in this population. Results: Eight hundred fifty-five eyes were analyzed, including 70 (8.2%) eyes with hyperopic refractions and 785 (91.8%) eyes with myopic refractions. After initial treatment, 72% of eyes were 20/20 or better and 99.5% were 20/40 or better. To improve uncorrected visual acuity, 54 (6.3%) eyes had retreatments performed. No significant differences in retreatment rates were noted based on age ( P =.15), sex ( P =.8), eye ( P =.3), PRK versus LASIK ( P =1.0), room temperature ( P =.1) or humidity ( P =.9), and no correlation between retreatment rate and month or season of primary surgery ( P =.4). There was no correlation between degree of myopia and retreatment rate. Eyes were significantly more likely to undergo retreatment if they were hyperopic (12.8% vs 6.0%, P =.006) or had astigmatism ⩾1.00 diopter (D) (9.1% vs 5.3%, P =.04). Conclusions: Retreatment rate was 6.3% with the WaveLight ALLEGRETTO WAVE excimer laser. This rate was not influenced by age, sex, corneal characteristics, or environmental factors. Eyes with hyperopic refractions or astigmatism ⩾1.00 D were more likely to undergo retreatment. [ J Refract Surg . 2009;25:273–276.]

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