A comparison of grating visual acuity, strabismus, and reoperation outcomes among children with aphakia and pseudophakia after unilateral cataract surgery during the first six months of life

Purpose: The method of correcting aphakia after unilateral cataract extract ion during infancy is controversial. Some authorities advocate correction w ith an intraocular lens (IOL) whereas others advocate correction with a con tact lens (CL). We compared grating visual acuity, alignment, and reoperati ve outcomes in age-matched children treated with these 2 modalities at 5 cl inical centers. Methods:Twenty-five infants born in 1997 or 1998 with a den se unilateral congenital cataract who had cataract surgery coupled with (IO L group, n = 12) or without (CL group, n = 13) primary IOL implantation wer e enrolled in this study. All patients were prescribed half-time occlusion therapy. In July 1999, their grating visual acuities, ocular alignments, an d reoperation rates were assessed. Results: The mean grating visual acuity (LogMAR) for the affected eye was 0.70 +/- 0.32 for the IOL group and 0.87 +/- 0.31 for the CL group (P=.19). The mean interocular difference in grati ng visual acuity was 0.26 +/- 0.30 for the IOL group and 0.50 +/- 0.28 for the CL group (P=.048). The incidence of strabismus (>10 PD) was 75% in the IOL group compared with 92% in the CL group (P=.24). The incidence of reope rations was 83% in the IOL group compared with 23% in the CL group (P=.003) , Conclusions: Our preliminary data suggest that correcting aphakia after u nilateral congenital cataract surgery with primary IOL implantation results in an improved visual outcome but a higher rate of complications requiring reoperation. A randomized clinical trial, the Infant Aphakia Treatment Stu dy, is planned to further study the optimal treatment for aphakia following unilateral cataract extraction during infancy.