Comparison of visual acuity and complications between primary IOL implantation and aphakia in patients with congenital cataract younger than 2 years: a meta-analysis

Abstract

To analyze the visual acuity and complications between primary intraocular lens (IOL) implantation and contact lens wearing, this literature search was performed with data on patients with congenital cataract younger than 2 years published in March 2019. Seven identified studies enrolling 675 eyes were selected for analysis. Patients with primary IOL implantation owned better visual acuity than those with aphakia who wore the contact lens (weighted mean difference = 0.161; 95% CI, 0.108-0.214). For visual axis opacification (VAO), primary IOL implantation increases the incidence of VAO compared with contact lens wearing (relative risk = 0.23; 95% CI, 0.13-0.42). No statistically significant difference was found between the 2 groups about the prevalence of glaucoma and strabismus. Primary IOL implantation achieved better visual outcomes after cataract extraction in patients younger than 2 years. In addition, no higher risk for complications among primary IOL implantation compared with contact lens wearing was noted. Therefore, implanting a primary IOL during congenital cataract surgery is a better therapy for children younger than 2 years than wearing a contact lens.

Clinical Features and Outcomes of Congenital Cataract Surgery with Primary Intraocular Lens Implantation in a Tunisian Cohort

“…There are also concerns about significant refractive errors resulting from the unpredictable ocular growth. 8 9…”

“…The authors concluded that patients with primary implantation owned better VA than those with aphakia but without significant statistical difference. 8 …”

“…However, the benefits and risks of primary implantation in infants younger than 2 years remain controversial. 7 8 9 10 11 12 13 14 15…”

Recent developments in the management of congenital cataract

“…Primary IOL implantation is usually performed in children older than 2 years of age. However, IOL implantation in children younger than 2 years of age remains a matter of controversy, despite the increasing evidence of safety for the procedure (16). IOL implantation before 7 months of age is considered at high risk of severe postoperative complications, as inflammation, PCO (Figure 1E) and glaucoma, particularly in bilateral cases (17)(18)(19).…”

“…The prevalence of glaucoma and strabismus was similar between the groups. Authors suggested that cataract surgery in children younger than 2 years should include primary IOL implantation, associated with optic capture or bag-in-the-lens IOL implantation techniques to reduce PCO incidence (16). However, when cataract is associated with others ocular conditions as microphthalmia, IOL implantation should be delayed (21).…”