Visual outcome and complications of bilateral intraocular lens implantation in children

Purpose: To determine the safety and efficacy of bilateral intraocular lens (IOL) implantation in children. Setting: Tertiary referral pediatric ophthalmology department. Methods: This retrospective study comprised 13 children (26 eyes) who had b ilateral cataract surgery with IOL implantation. Patients were divided into 2 groups: congenital cases, diagnosed during the first year of life, and d evelopmental cases, diagnosed after 1 year of age. All patients had small i ncision phacoemulsification with primary implantation of a poly(methyl meth acrylate) or a foldable acrylic IOL. Primary posterior capsulotomy was perf ormed in 16 eyes(61.5%). Results: Age at surgery ranged from 1 week to just under 8 years. Seven pat ients (53.8%) had a systemic diagnosis: Down's syndrome (n = 4); developmen tal delay or cerebral atrophy (n = 3). Five children with systemic problems could not cooperate with formal Vision testing; 2 could fix and follow bil aterally, and Shad central, steady, and maintained vision bilaterally. In t he congenital group, 37.5% of eyes attained a visual acuity of 20/20 and 87 .5%, 20/120 or better; In the developmental group, formal vision testing wa s possible in 4 children. Five eyes (83.3%) attained a visual acuity of 20/ 40 or better. Thirteen eyes (50.0%) required posterior capsulotomy. Primary posterior capsulotomy reduced the incidence of posterior capsule opacifica tion (PCO), but there was no correlation between PCO and IOL material. One patient developed glaucoma bilaterally. Conclusion: Bilateral IOL implantation was safe and produced good visual re sults in children of all ages with bilateral cataract. J Cataract Refract S urg 2000; 26: 1758-1764 (C) 2000 ASCRS and ESCRS.