Outcomes of Bilateral Cataracts Removed in Infants 1 to 7 Months of Age Using the Toddler Aphakia and Pseudophakia Treatment Study Registry

Abstract

To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes.Design: Retrospective case series review at 10 IATS sites.Participants: The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS.Methods: Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010.Main Outcome Measures: Visual acuity (VA), strabismus, adverse events (AEs), and reoperations.Results: One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1e7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00e1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (<20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (<9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P ¼ 0.037; and smaller cornea: OR, 3.95; P ¼ 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P ¼ 0.023; and smaller cornea: OR, 4.78; P ¼ 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P ¼ 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%).Conclusions: Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea. Ophthalmology 2020;127:501-510 ª 2019 by the American Academy of Ophthalmology Supplemental material available at www.aaojournal.org. MethodsThis study was approved by the institutional review board or ethics review board at all participating institutions (Mayo Clinic,

Long-term outcome of primary intraocular lens implantation in bilateral congenital cataract in infants with a median age of 35 days at surgery: a case series

“…This was somewhat inferior to the visual outcome of the Toddler Aphakia and Pseudophakia study (TAPS). 9 However, they excluded most children with chromosomal and neurodevelopmental anomalies from the visual acuity summaries, and the age at surgery was 1 to 7 months. After removing the children with Down syndrome and the one with Lowe syndrome from our study, the median CDVA of the better-seeing eye was comparable to the TAPS study.…”

Expanding the Phenotypic Spectrum of PAX6 Mutations: From Congenital Cataracts to Nystagmus

“…This phenotype has not been classically associated with PAX6 mutations. Bilateral congenital cataract usually has a good visual prognosis if surgery is performed between 6 and 8 weeks old and no other ocular abnormalities are seen [ 18 ]. Patients with PAX6 mutations often had posterior pole abnormalities such as foveal hypoplasia, which might be difficult to diagnose in a young infant presenting with congenital cataracts, as this patient will characteristically present nystagmus at a low visual acuity, like case 4, 7 and 8.…”

In-the-Bag Versus Ciliary Sulcus Secondary Intraocular Lens Implantation for Pediatric Aphakia: A Prospective Comparative Study

“…Treatment Study Registry (TAPS) and the IoLunder2 cohort, demonstrating that GRAE is a common complication threatening visual prognosis after cataract surgery in infants and young children, 3,[23][24][25] with incidence increasing gradually over the postoperative interval. The Infant Aphakia Treatment Study (IATS) reported that the incidence of GRAE in children aged one to six months at the time of cataract extraction rose from 12% at 1 year to 40% at 10 years after surgery.…”

“…Secondary intraocular lens (IOL) implantation is a common treatment for pediatric aphakia. [1][2][3] In short to mid-term follow-up of 12 to 60 months, the incidence of adverse events (AEs) after IOL implantation in pediatric aphakia has been reported to be as high as 19.5 -28.5%, affecting the prognosis and visual function in these patients. [4][5][6][7][8] In most pediatric aphakic eyes, after cataract extraction, the amount of residual lens capsule is insufficient, or the anterior and posterior capsules of the lens are adherent and scarred, so an IOL can only be implanted in the ciliary sulcus.…”