Contact lenses for infant aphakia.

Hospital for Sick Children, London.
British Journal of Ophthalmology (Impact Factor: 2.81). 04/1990; 74(3):150-4. DOI: 10.1136/bjo.74.3.150
Source: PubMed

ABSTRACT We prospectively studied for three years the optical correction by contact lenses of 83 aphakic infants (141 eyes) who generally also had systemic and other ocular anomalies: 85% of the patients tolerated the lens wear for the whole study period. Complications occurred in 46 eyes and led to cessation of lens wear in two cases. Ten patients abandoned the lenses for other reasons. Thirty-four eyes needed subsequent intraocular surgery, mostly minor, and nine patients had strabismus surgery. Contact lenses are a versatile, safe, successful, and cost effective treatment for aphakia in infancy against which, before their widespread introduction for primary optical correction of infant aphakia, other methods of aphakic treatment need to be compared.

  • [Show abstract] [Hide abstract]
    ABSTRACT: PurposeTo compare primary intra-ocular lens (IOL) implantation with use of press-on spherical lens for aphakia correction following unilateral infantile cataract removal. Methods Sixty infants with a unilateral cataract underwent cataract surgery and were randomly assigned to the IOL (A group) or no IOL group (B group). Residual refractive error was corrected with spectacles in the A group and a press-on spherical lens was used to treat aphakia in the B group. Grating visual acuity (VA) was measured and patients were followed for up to 1year. ResultsLogMAR VA in the operated eyes of both groups was significantly better 1year than 1month after surgery. Mean logMAR VA difference between 1year and 1month after surgery was higher in the A group (0.4570.110) than in the B group (0.323 +/- 0.114, p<0.0001). Serious inflammation occurred significantly more often in the A group than in the B group (p=0.007). Visual axis opacity occurred more often in the A group than in the B group (pupillary membrane: A: six eyes, 20%, B: none, p=0.024; lens reproliferation: A: 10 eyes, 33%, B: two eyes, 7%, p=0.021). Glaucoma occurred equally in both groups (p=0.612). No other complications occurred. Conclusions Primary IOL implantation appears to be a relatively safe, effective optical correction strategy following unilateral cataract extraction in this age group. Patients for whom an IOL is not suitable can be treated with a press-on spherical lens for optical correction.
    Acta ophthalmologica 06/2014; 92(8). DOI:10.1111/aos.12465 · 2.51 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To describe follow-up and evaluate functional results of rigid gas-permeable contact lens wear for the correction of aphakia in infants after surgery for congenital cataract. Patients and methods This retrospective study was performed on 23 eyes of 17 children (12 boys and five girls), between three days and 36 months of age (median 3.5 months), undergoing cataract extraction without primary intraocular lens implantation and fitted only with Menicon® Z material contact lenses. Initial fitting visits included history and family education. Subsequent examinations were performed at eight days, 15 days, 1 month, 6 months and 1 year. The four main parameters studied were fit characteristics, ease of manipulation, ocular integrity and lens integrity. Concurrently, functional results (visual acuity, oculomotor balance) and various prognostic factors (associated pathology, age at time of surgery, cataract density, unilaterality versus bilaterality, postoperative complications) were evaluated. Rigorous systematic amblyopia rehabilitation was performed. Results At the one-month exam, 60% of parents demonstrated proficiency with manipulating the lens. On one-year follow-up, three cases of failure were attributable to difficulties with lens manipulation. At one year, one infectious complication was detected. The lens material demonstrated good resistance to breakage (9% at one month) and only a mild tendency toward deposits (few or no deposits in 95% of cases at 1 month). With regard to visual outcome, among the children old enough to cooperate, visual acuity was better than 3/10 for nine out of 12 eyes, of which five eyes were 10/10. With regard to alignment, we noted 12 cases (70.6%) of strabismus postoperatively (ten esotropia, two exotropia). The factors predictive of good visual acuity correlated with those described in the literature: partial cataract, bilateral cataract, and absence of postoperative oculomotor disturbance. Conclusion The characteristics of rigid gas-permeable contact lenses provide safety and efficacy in aphakic infant eyes. They represent an attractive alternative to primary intraocular lens implantation in congenital cataract.
    Journal francais d'ophtalmologie 10/2012; 35(8):599–605. DOI:10.1016/j.jfo.2012.04.003 · 0.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the visual outcomes and adverse events of contact lens with primary intraocular lens (IOL) correction of monocular aphakia during infancy. In a randomized, multicenter (12 sites) clinical trial, 114 infants with a unilateral congenital cataract were assigned to undergo cataract surgery between 1 to 6 months of age either with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Grating visual acuity was tested at 1 year of age by a masked traveling examiner. Grating visual acuity at 1 year of age. The median logMAR visual acuity was not significantly different between the treated eyes in the 2 groups (contact lens group, 0.80; IOL group, 0.97; P = .19). More patients in the IOL group underwent 1 or more additional intraocular operations than patients in the contact lens group (63% vs 12%; P < .001). Most of these additional operations were performed to clear lens reproliferation and pupillary membranes from the visual axis. There was no statistically significant difference in grating visual acuity at age 1 year between the IOL and contact lens groups; however, additional intraocular operations were performed more frequently in the IOL group. Until longer-term follow-up data are available, caution should be exercised when performing IOL implantation in children aged 6 months or younger given the higher incidence of adverse events and the absence of an improved short-term visual outcome compared with contact lens use.
    Archives of ophthalmology 01/2010; 128(7):810-818. DOI:10.1001/archophthalmol.2010.101 · 4.49 Impact Factor


Available from