Axial Elongation following Cataract Surgery during the First Year of Life in the Infant Aphakia Treatment Study

Department of Ophthalmology, Emory University, Emory Eye Center, 1365-B Clifton Rd, Atlanta, GA, 30322, United States.
Investigative ophthalmology & visual science (Impact Factor: 3.4). 10/2012; 53(12). DOI: 10.1167/iovs.12-10285
Source: PubMed


To compare ocular axial elongation in infants after unilateral cataract surgery corrected with a contact lens (CL) or primary intraocular lens (IOL) implantation.

Baseline axial length (AL) was measured at the time of cataract surgery (1-6 months) and at age 1 year. AL at baseline and age 1 year and the change in length/mo were analyzed in relation to treatment modality, cataractous versus fellow eye, and age at surgery using linear mixed models.

Mean baseline AL did not differ between the CL and IOL groups for either cataractous or fellow eyes. Eyes with cataracts were shorter than fellow eyes by an average of 0.6 mm (95% confidence interval [CI], 0.4-0.8 mm; P < 0.0001). For the operated eyes, the mean change in AL/mo was smaller in the CL group (0.17 mm/mo) than in the IOL group (0.24 mm/mo) (P = 0.0006) and was independent of age at surgery (P = 0.19). In contrast, the change in AL/mo for fellow eyes decreased with older age at surgery (P < 0.0001). At age 1 year, operated eyes treated with a CL were 0.6 mm shorter on average than operated eyes treated with an IOL (P = 0.009).

At baseline, eyes with cataracts were shorter than fellow eyes. The change in AL/mo was smaller in operated eyes treated with a CL than in operated eyes treated with an IOL, but was not significantly related to age at surgery. ( number, NCT00212134.).

Download full-text


Available from: Lindreth G Dubois, Jun 09, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To compare accuracy of intraocular lens (IOL) power calculation formulae in infantile eyes with primary IOL implantation. Design Comparative case series. Methods The Hoffer Q, Holladay 1, Holladay 2, Sanders-Retzlaff-Kraff (SRK) II, and Sanders-Retzlaff-Kraff theoretic (SRK/T) formulae were used to calculate predicted postoperative refraction for eyes that received primary IOL implantation in the Infant Aphakia Treatment Study. The protocol targeted postoperative hyperopia of +6.0 or +8.0 diopters (D). Eyes were excluded for invalid biometry, lack of refractive data at the specified postoperative visit, diagnosis of glaucoma or suspected glaucoma, or sulcus IOL placement. Actual refraction 1 month after surgery was converted to spherical equivalent and prediction error (predicted refraction − actual refraction) was calculated. Baseline characteristics were analyzed for effect on prediction error for each formula. The main outcome measure was absolute prediction error. Results Forty-three eyes were studied; mean axial length was 18.1 ± 1.1 mm (in 23 eyes, it was <18.0 mm). Average age at surgery was 2.5 ± 1.5 months. Holladay 1 showed the lowest median absolute prediction error (1.2 D); a paired comparison of medians showed clinically similar results using the Holladay 1 and SRK/T formulae (median difference, 0.3 D). Comparison of the mean absolute prediction error showed the lowest values using the SRK/T formula (1.4 ± 1.1 D), followed by the Holladay 1 formula (1.7 ± 1.3 D). Calculations with an optimized constant showed the lowest values and no significant difference between the Holladay 1 and SRK/T formulae (median difference, 0.3 D). Eyes with globe AL of less than 18 mm had the largest mean and median prediction error and absolute prediction error, regardless of the formula used. Conclusions The Holladay 1 and SRK/T formulae gave equally good results and had the best predictive value for infant eyes.
    Full-text · Article · Dec 2013 · American Journal of Ophthalmology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Importance The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown.Objective To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy.Design, Setting, and Participants The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. Interventions Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment.Main Outcomes and Measures HOTV optotype visual acuity at 4.5 years of age.Results The median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001).Conclusions and Relevance There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia.Trial Registration Identifier: NCT00212134
    No preview · Article · Mar 2014 · Jama Ophthalmology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation. Design Prospective randomized clinical trial. Methods 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character and severity of intraoperative complications, adverse events and additional intraocular surgeries during the first five postoperative years in the two groups were examined. Results There were more patients with intraoperative complications (28% vs. 11%, p=.031), adverse events (81% vs 56%, p = 0.008) and more additional intraocular surgeries (72% vs 16%, p < 0.0001) in the IOL group than the contact lens group. However, the number of patients with adverse events in the contact lens group increased (15 to 24) in post op years 2-5 compared to the first post op year, while it decreased (44 to 14) in years 2-5 compared to the first post op year in the IOL group. If only one-half of the patients in the contact lens (aphakic) group eventually undergo secondary IOL implantation, the number of additional intraocular surgeries in the two groups will be approximately equal. Conclusion The increased rate of complications, adverse events and additional intraocular surgeries associated with IOL implantation in infants <7 mos of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction.
    No preview · Article · Nov 2014 · American Journal of Ophthalmology
Show more