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Abstract #19742 Published in IGR 9-4
ASCRS white paper. Hydrophobic acrylic intraocular lenses in children
Wilson Jr ME; Trivedi RH; Buckley EG; Granet DB; Lambert SR; Plager DA; Sinskey RM; Vasavada ARJournal of Cataract and Refractive Surgery 2007; 33: 1966-1973
1. Hydrophobic acrylic IOLs have improved the intraoperative performance of pediatric cataract surgery. These hydrophobic acrylic IOLs not only allow easier and safer implantation in small (even microphthalmic) pediatric eyes, they also help the surgeon consistently achieve the desired in-the-bag fixation in these eyes. 2. We recommend hydrophobic acrylic IOL implantation in children. Implantation is usually combined with a posterior capsulectomy and an anterior vitrectomy from infancy until the age of five years. In children older than an infant, combined posterior capsulectomy, vitrectomy, and hydrophobic acrylic IOL implantation avoids the need for a secondary intervention in most eyes. 3. In the eyes of infants, VAO is much more common when an IOL of any type is implanted than in cases of primary aphakia, even when a posterior capsulectomy and an anterior vitrectomy are performed. Surgical removal of VAO is usually uncomplicated and rarely has to be repeated. 4. In pediatric eyes with an intact posterior capsule, PCO develops in most eyes, even those with hydrophobic acrylic IOLs. However, some studies document a delay in PCO development in eyes with hydrophobic acrylic IOLs compared with eyes with PMMA IOLs. This delay may allow the child to reach an age at which he or she can cooperate during an Nd:YAG laser capsulotomy in the office. Also, during the amblyopic ages, any delay in the onset or progression of PCO may be beneficial. In children, proliferative PCO is more common with hydrophobic acrylic IOLs than with PMMA IOLs, with which fibrous PCO is more common. 5. Patients having cataract surgery during early infancy are at high risk for the development of glaucoma with or without IOL implantation. Children who have surgery and IOL implantation later in childhood are at a much lower risk for glaucoma. 6. Finally, an IOL implanted in a child's eye must remain there for several decades, perhaps 70 years or more, without biodegrading. To date, hydrophobic acrylic IOLs have been found to be efficacious in providing good short-term to intermediate-term results after implantation in pediatric cataract surgery. Longer-term outcomes will continue to be evaluated.
Classification:
9.4.11.2 Glaucomas in aphakia and pseudophakia (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)
9.1.2 Juvenile glaucoma (Part of: 9 Clinical forms of glaucomas > 9.1 Developmental glaucomas)
