Bilateral trifocal IOL implantation in a pediatric case of cataract following steroid-therapy for acute lymphoblastic leukemia

Abstract

PurposeTo present the case of a 9-year-old child with bilateral posterior subcapsular cataract developed through steroid treatment for acute lymphoblastic leukemia. Cataract surgery with trifocal intraocular lens implantation was performed in both eyes.ObservationsUncorrected distance visual acuity increased from +0.3 and + 0.4 logMAR preoperatively to 0.00 and + 0.04 logMAR after surgery. Binocular uncorrected values for intermediate and near visual acuity were −0.04 logMAR and 0.02 logMAR after surgery, respectively. The patient did not report side effects like halos or glare and was able to participate in his daily activities (school and sports) without spectacles.Conclusions and ImportanceThis report represents the first description of a bilateral implantation of trifocal intraocular lenses in a pediatric cataract case with restoration of visual function in far, intermediate and near distance. Trifocal intraocular lenses to compensate for the loss of accommodation can be an option in selected cases of children with cataract.

Reversible Trifokalität durch das Duett-Verfahren

“…Die Reversibilität ist insbesondere deswegen von Vorteil, weil trifokale Optiken oft bei jüngeren Patienten eingesetzt werden. Zwar kann die Implantation von trifokalen Linsen auch bei sehr jungen Patienten zu guten funktionellen Ergebnissen führen, zum Zeitpunkt der Implantation lässt sich aber nicht sicher vorhersagen, ob der Patient nicht später doch Erkrankungen entwickelt, die eine Kontraindikation für eine trifokale IOL wären [18]. Bei Patienten, die im Laufe des Lebens eine solche Pathologie am hinteren Augenabschnitt (z.…”

Reversibility of the duet procedure: Bilateral exchange of a supplementary trifocal sulcus-fixated intraocular lens for correction of a postoperative refractive error

“…20 Performing cataract surgery in children can be challenging as the growth of the eye inevitably leads to a change in refraction. 21 The implantation of a supplementary IOL in this scenario is a promising treatment option, as it is suggested the lenses can be easily exchanged as the eye ages and intraocular dimensions change.…”

Trifocal toric intra-ocular lens implantation in pediatric traumatic cataract

“…Questions regarding refractive shift after IOL implantation in children due to ocular development are discussed in the literature and some attention must be paid to IOL calculation, especially in children under age 2 years 1 . Amblyopia must be carefully considered when deciding what lens to select 6 . During childhood, neuroplasticity allows neuroadaptation and reduces photic phenomena 6 .…”

“…Amblyopia must be carefully considered when deciding what lens to select 6 . During childhood, neuroplasticity allows neuroadaptation and reduces photic phenomena 6 . However, the possibility of glasses, contact lens or even laser correction for a potential residual refraction after cataract surgery in children is well established 7 , 8 .…”

“…The most common cataract surgery technique in such cases is use of a monofocal IOL targeting hyperopia (depending on patient age), with a plan for spectacle correction 1 , 6 , 9 . We chose an alternative option for our patient, implanting a toric trifocal IOL aiming for the first positive value from emmetropia.…”