Contact lenses for infant aphakia.

Hospital for Sick Children, London.
British Journal of Ophthalmology (Impact Factor: 2.73). 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.

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    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. · 3.86 Impact Factor
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    ABSTRACT: We evaluated 21 eyes of 13 infants between two and eight months old who had primary posterior chamber intraocular lens (IOL) implantation for congenital cataracts between 1988 and 1993. Twelve eyes had a posterior capsulorhexis or plaque peeling at the time of implantation and one eye had a vitrectomy. Eight eyes had no posterior capsule procedure during the initial surgery. Follow-up ranged from six months to five years. All eyes developed one or multiple posterior synechias and all, except one, required secondary capsulectomy and vitrectomy between one month and one year. Twenty eyes attained stable IOL fixation and a clear visual axis. In one eye, the IOL decentered downward. Patients with bilateral cataracts had greater visual improvement than those with a cataract in one eye only. No patient could manage spectacles postoperatively. Our findings show the benefits of posterior capsulectomy and anterior vitrectomy done in the early postoperative period and that IOL implantation in infants is a reasonable treatment in some parts of the world.
    Journal of Cataract and Refractive Surgery 12/1994; 20(6):592-8. · 2.53 Impact Factor
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    ABSTRACT: The safety and efficacy of correcting monocular aphakia during infancy with an intraocular lens was evaluated using a monkey model. The study was conducted at the Yerkes Regional Primate Research Center. A translucent contact lens was placed on the right eye of a group of newborn Rhesus monkeys to simulate a congenital cataract. When the monkeys were 2-weeks-old, a lensectomy was performed on the right eye coupled with the implantation of an intraocular lens (IOL) into the posterior chamber. The fellow eyes were then randomized to part-time occlusion therapy or no treatment. The monkeys were then examined at regular intervals for complications. Visual acuity and contrast sensitivity was evaluated using forced-choice preferential looking and operant testing. The pseudo-phakic eyes were studied histopathologically at the end of the study. A variety of complications occurred postoperatively including fibrin encapsulation of the intraocular lens, glaucoma, haptic breakage, and lens reproliferation into the pupillary space. Grating acuities were excellent for the pseudophakic eyes of the monkeys that received part-time occlusion therapy, but severely reduced in the pseudophakic eyes of the monkeys that received no treatment of the fellow eyes. An unexpected finding was that the pseudophakic eyes were consistently shorter than their fellow phakic eyes. The implantation of an intraocular lens into an infantile monkey eye can be associated with a variety of serious complications. Intraocular lenses custom-designed for infantile eyes may reduce the incidence of these complications. In eyes not developing these complications, excellent visual acuities can be obtained if the fellow eyes are occluded part-time.
    Seminars in Ophthalmology. 01/1997; 12(2):81-88.


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