Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy.

Importance: Glaucoma can develop following cataract removal in children. Objective: To assess the cumulative incidence of glaucoma-related adverse events (defined as glaucoma or glaucoma suspect) and factors associated with risk of these adverse events in the first 5 years after lensectomy prior to 13 years of age. Design, Setting, and Participants: This cohort study used longitudinal registry data collected at enrollment and annually for 5 years from 45 institutional and 16 community sites. Participants were children aged 12 years or younger with at least 1 office visit after lensectomy from June 2012 to July 2015. Data were analyzed from February through December 2022. Exposures: Usual clinical care after lensectomy. Main Outcomes and Measures: The main outcomes were cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of these adverse events. Results: The study included 810 children (1049 eyes); 443 eyes of 321 children (55% female; mean [SD] age, 0.89 [1.97] years) were aphakic after lensectomy, and 606 eyes of 489 children (53% male; mean [SD] age, 5.65 [3.32] years) were pseudophakic. The 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% CI, 25%-34%) in 443 eyes with aphakia and 7% (95% CI, 5%-9%) in 606 eyes with pseudophakia; 7% (95% CI, 5%-10%) of aphakic eyes and 3% (95% CI, 2%-5%) of pseudophakic eyes were diagnosed as glaucoma suspect. Among aphakic eyes, a higher risk for glaucoma-related adverse events was associated with 4 of 8 factors, including age less than 3 months (vs ≥3 months: adjusted hazard ratio [aHR], 2.88; 99% CI, 1.57-5.23), abnormal anterior segment (vs normal: aHR, 2.88; 99% CI, 1.56-5.30), intraoperative complications at time of lensectomy (vs none; aHR, 2.25; 99% CI, 1.04-4.87), and bilaterality (vs unilaterality: aHR, 1.88; 99% CI, 1.02-3.48). Neither of the 2 factors evaluated for pseudophakic eyes, laterality and anterior vitrectomy, were associated with risk of glaucoma-related adverse events. Conclusions and Relevance: In this cohort study, glaucoma-related adverse events were common after cataract surgery in children; age less than 3 months at surgery was associated with elevated risk of the adverse events in aphakic eyes. Children with pseudophakia, who were older at surgery, less frequently developed a glaucoma-related adverse event within 5 years of lensectomy. The findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age.

Retrospective study of secondary implantation of retroiridial fixation lenses in patients without capsular support: functional results and complications.

INTRODUCTION: The correction of aphakia when there is no adequate capsular support remains a therapeutic challenge. The use of retroiridial fixation lenses has been extended given their lower complication rate compared to other available options. MATERIAL AND METHODS: Retrospective study including all cases operated with an Artisan® retropupillary aphakia implant. RESULTS: 33 eyes were included out of a total of 28 patients. The follow-up period has been 38.55 months (1-96). 32.3% had a lens dislocation and 67.7% had an intraocular lens dislocation. The previous mean best corrected visual acuity (BCVA) was 1.18 ± 0.79 logMAR and post-intervention 0.36 ± 0.62 (p < 0.01). 93.8% of the patients presented a final BCVA equal to or better and 62.5% an improvement of 3 or more lines. The most frequent complication was corectopia (31.3%) and hypotony in the immediate postoperative period (21.9%). An epiretinal membrane (ERM) developed in 18.8% and cystic macular oedema (CME) in 9.4%. The presence of complications in the postoperative period did not statistically influence the final BCVA. CONCLUSIONS: The retropupillary Artisan® lens allows the correction of aphakia with satisfactory visual results and a low rate of complications.

Visual Acuity and Ophthalmic Outcomes 5 Years After Cataract Surgery Among Children Younger Than 13 Years.

IMPORTANCE: Cataract is an important cause of visual impairment in children. Data from a large pediatric cataract surgery registry can provide real-world estimates of visual outcomes and the 5-year cumulative incidence of adverse events. OBJECTIVE: To assess visual acuity (VA), incidence of complications and additional eye operations, and refractive error outcomes 5 years after pediatric lensectomy among children younger than 13 years. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from the Pediatric Eye Disease Investigator Group clinical research registry. From June 2012 to July 2015, 61 eye care practices in the US, Canada, and the UK enrolled children from birth to less than 13 years of age who had undergone lensectomy for any reason during the preceding 45 days. Data were collected from medical record reviews annually thereafter for 5 years until September 28, 2020. EXPOSURES: Lensectomy with or without implantation of an intraocular lens (IOL). MAIN OUTCOMES AND MEASURES: Best-corrected VA and refractive error were measured from 4 to 6 years after the initial lensectomy. Cox proportional hazards regression was used to assess the 5-year incidence of glaucoma or glaucoma suspect and additional eye operations. Factors were evaluated separately for unilateral and bilateral aphakia and pseudophakia. RESULTS: A total of 994 children (1268 eyes) undergoing bilateral or unilateral lensectomy were included (504 [51%] male; median age, 3.6 years; range, 2 weeks to 12.9 years). Five years after the initial lensectomy, the median VA among 701 eyes with available VA data (55%) was 20/63 (range, 20/40 to 20/100) in 182 of 316 bilateral aphakic eyes (58%), 20/32 (range, 20/25 to 20/50) in 209 of 386 bilateral pseudophakic eyes (54%), 20/200 (range, 20/50 to 20/618) in 124 of 202 unilateral aphakic eyes (61%), and 20/65 (range, 20/32 to 20/230) in 186 of 364 unilateral pseudophakic eyes (51%). The 5-year cumulative incidence of glaucoma or glaucoma suspect was 46% (95% CI, 28%-59%) in participants with bilateral aphakia, 7% (95% CI, 1%-12%) in those with bilateral pseudophakia, 25% (95% CI, 15%-34%) in those with unilateral aphakia, and 17% (95% CI, 5%-28%) in those with unilateral pseudophakia. The most common additional eye surgery was clearing the visual axis, with a 5-year cumulative incidence of 13% (95% CI, 8%-17%) in participants with bilateral aphakia, 33% (95% CI, 26%-39%) in those with bilateral pseudophakia, 11% (95% CI, 6%-15%) in those with unilateral aphakia, and 34% (95% CI, 28%-39%) in those with unilateral pseudophakia. The median 5-year change in spherical equivalent refractive error was -8.38 D (IQR, -11.38 D to -2.75 D) among 89 bilateral aphakic eyes, -1.63 D (IQR, -3.13 D to -0.25 D) among 130 bilateral pseudophakic eyes, -10.75 D (IQR, -20.50 D to -4.50 D) among 43 unilateral aphakic eyes, and -1.94 D (IQR, -3.25 D to -0.69 D) among 112 unilateral pseudophakic eyes. CONCLUSIONS AND RELEVANCE: In this cohort study, development of glaucoma or glaucoma suspect was common in children 5 years after lensectomy. Myopic shift was modest during the 5 years after placement of an intraocular lens, which should be factored into implant power selection. These results support frequent monitoring after pediatric cataract surgery to detect glaucoma, visual axis obscuration causing reduced vision, and refractive error.

Real world outcomes of sutureless and glueless sclerally fixated intraocular lens implantation.

PURPOSE: To report the outcomes of sutureless intrascleral fixation of a 3-piece intraocular lens in the ciliary sulcus, in a large cohort of patients with aphakia of various aetiology METHODS: Retrospective, non-comparative, single centre interventional study of 250 aphakic eyes of various causes, which underwent sutureless and glueless intrascleral fixation of 3-piece intraocular lens (IOL). All patients were required to have at least 3 months of follow up post procedure to be included in the study. Anatomical and functional outcomes obtained were statistically analysed for significance. RESULTS: A total of 250 eyes of 246 patients were included in the study population. The average age was 56.5 years ± 16.4 (range 6-86 years). The mean best-corrected visual acuity (BCVA) significantly improved from 0.74 ± 0.6 logMAR (approx. Snellen equivalent 20/110) to 0.48 ± 0.36 logMAR (approx. Snellen equivalent 20/60), (p < 0.001) following surgery. Early postoperative complication (<2 weeks) included hypotony (n = 10, 4%), ocular hypertension (n = 38,15.2%) and vitreous haemorrhage (n = 50, 20%). Late complications included retinal detachment (n = 14, 5.6%%), cystoid macular oedema (n = 24, 9.6%), scleral erosion (n = 1, 0.4%), haptic extrusion to subconjunctival space (n = 3, 1.2%) and IOL subluxation or dislocation (n = 5, 2%) CONCLUSION: This cost-effective and easier technique of sutureless scleral fixated 3-piece IOL implantation provided good visual acuity outcomes in a large cohort of patients and was well tolerated.

Glaucoma following Infant Lensectomy: 2021 Update.

PURPOSE: To review information pertaining to glaucoma following infant lensectomy surgery and to provide evidence to support the responsible mechanism of this condition. METHODS AND RESULTS: Described risk factors and proposed mechanisms for infantile aphakic glaucoma were assessed. The clinical evidence observed in affected glaucoma patients was analyzed, and evidence of postoperative anterior chamber fibrosis was reviewed and interpreted. CONCLUSION: The review and assessment of laboratory and clinical evidence support the proposal that infantile aphakic glaucoma is caused, in part, by postoperative anterior chamber fibroization related to lens cell dispersion and active epithelial-mesenchymal transition with resultant filtration angle tissue injury and loss of function.

The Myopic Shift in Aphakic Eyes in the Infant Aphakia Treatment Study After 10 Years of Follow-up.

OBJECTIVES: To report the myopic shift in the aphakic eyes of a cohort of children who underwent unilateral cataract surgery during infancy and were then followed longitudinally for 10.5 years. METHODS: One-half of the children enrolled in the Infant Aphakia Treatment Study (IATS) were randomized to aphakia and contact lens correction after unilateral cataract surgery. They then underwent ocular examinations using standardized protocols at prescribed time intervals until age 10.5 years. RESULTS: Thirty of 57 children randomized to aphakia remained aphakic at age 10.5, having undergone unilateral cataract surgery at a median age of 1.6 (IQR: 1.1-3.1) months. The median refractive error (RE) in the 57 eyes randomized to aphakia immediately after cataract surgery was 19.01 D (IQR: 16.98-20.49) compared to 10.38 D (IQR: 7.50-14.00) for the 30 eyes that remained aphakic at age 10.5 years. The mean change in RE in aphakic eyes was -2.11 D/year up to age 1.5 years, -0.68 D/year from 1.5 to 5.0 years, and -0.35 D/year from age 5 to 10.5 years. At age 10.5 years, 18 patients continued to wear a contact lens correction (silicone elastomer, n=6; gas permeable, n=6; hydrogel, n=5; and silicone hydrogel, n=1) (median RE, 12.50 D), 9 wore only spectacles (median RE, 4.00 D), and 4 wore no correction (median RE, 11.25 D) to correct their aphakic eye. CONCLUSIONS: The RE in aphakic eyes decreased by 44% from infancy to age 10.5 years. About two-thirds of children who remained aphakic at age 10.5 years continued to wear a contact lens.

Cataract surgery contributes to ocular axis growth of aphakic eyes in infants with complex microphthalmos.

To observe the ocular axis, visual acuity and intraocular pressure (IOP) of aphakic eye in infants with congenital cataract and complex microphthalmos after first-stage cataract surgery.This retrospective study included infants with congenital cataract and operated at the Qingdao Eye Hospital between January 2010 and December 2014. The infants were divided into 2 groups: preoperative axial length <18 mm (microphthalmos) or ≥18 mm (controls). Follow-up lasted 24 months; visual acuity, axial length, and IOP were evaluated.There were 28 infants (55 eyes) in the microphthalmos group and 35 (61 eyes) in the control group. The preoperative visual acuity was negative for optokinetic nystagmus, while the postoperative visual acuity was positive for optokinetic nystagmus in both groups. The growth rate was higher in the microphthalmos group (1.4 ±â€Š0.8 vs 0.8 ±â€Š0.4 mm/yr, P < .001 vs controls). The axial length was smaller in the microphthalmos group at all time points compared with the control group (all P < .001). There was no changes in IOP in the microphthalmos group from baseline to 24 months (P = .147), but the IOP was slightly decreased in the control group (P = .015).Cataract surgery may contribute to ocular axis growth in infants with complex microphthalmos.

Globe Axial Length Growth at Age 10.5 Years in the Infant Aphakia Treatment Study.

PURPOSE: To report the change in globe axial length (AL) from the time of unilateral cataract surgery at age 1-7 months to age 10.5 years for infants enrolled in the Infant Aphakia Treatment Study, and to compare AL growth of operated eyes with that of fellow unoperated eyes. DESIGN: Comparative case series. METHODS: AL growth was analyzed relative to treated vs fellow eye, contact lens (CL) vs intraocular lens (IOL), visual acuity (VA) outcome, and the need for surgery for visual axis opacification. Eyes with glaucoma or glaucoma suspect were excluded from the primary analysis but reported separately. RESULTS: Fifty-seven patients have reliable AL data available at both visits. AL was shorter in treated eyes preoperatively (P < .0001) and at 10.5 years of age (P = .021) but AL growth was not different (4.7 mm, P = .99). The growth (70.2% up to age 5 and 29.8% from age 5 to 10.5) was similar in the CL and the IOL group (P = .79). Eyes grew 4.4 mm when visual acuity (VA) was better than 20/200, and 5.2 mm when VA was 20/200 or worse (P = .076). Eyes receiving additional surgery grew more than eyes not receiving additional surgery (P = .052). Patients with glaucoma showed significantly more eye growth (7.3 mm) than those without glaucoma (4.7 mm) and glaucoma suspects (5.1 mm) (P < .05). CONCLUSIONS: Eyes with glaucoma or poor VA often grew longer than the fellow eye. Overall, treated eyes grew similarly in the IOL and CL groups and also kept pace with the growth of the fellow eyes.

Supracapsular fixation for repositioning Ahmed glaucoma valve in case with tube-endothelial touch.

A new technique of correcting tube-corneal touch is described in a case of Ahmed glaucoma valve implantation. This technique repositions the intracameral tube without externalization unlike the standard procedures which aim to correct tube-corneal touch. The technique makes use of a transscleral supracapsular anchor suture to facilitate repositioning of the tube within the ciliary sulcus. Feasible only in pseudophakic and aphakic patients, either a preexisting iridectomy or intraoperative iridectomy is an essential prerequisite to perform this procedure. The final positioning of the tube within the sulcus potentially prevents chronic rubbing of the iris by polypropylene suture as opposed to a transcameral suture.

Risk of aphakic glaucoma after pars plana-lensectomy with and without removal of the peripheral lens capsule.

BACKGROUND: The etiology of aphakic glaucoma is unclear. It has been suggested that remaining lens epithelium releases cytokines transducing trabecular meshwork cells. Therefore, we compared two cohorts of children undergoing lensectomy. In cohort 1, the entire lens including its capsule was removed, in cohort 2 the peripheral lens capsule was left intact, also to facilitate secondary intraocular lens implantation later on. METHODS: We included children with uni- or bilateral congenital cataract who underwent lensectomy during the first year of life with subsequent contact lenses fitting. Group 1 comprised 41 eyes, group 2 comprised 33 eyes. In group 1, the median age at surgery was 4.0 months in unilateral and 3.0 months in bilateral cases 1, in group 2, 8.1 months and 2.4 months, respectively. The mean follow-up was 12.8 years in group 1 and 9.3 years in group 2. All cases were analyzed for the prevalence of aphakic glaucoma, for visual acuity and for compliance in visual rehabilitation (contact lens/occlusion therapy). RESULTS: We found no significant difference in glaucoma prevalence between group 1 and group 2 (p = 0.68). The overall glaucoma rate was 26% after the mean follow-up of 11 years in both groups. In unilateral cases, the median visual acuity was logMAR 0.7 in both groups. In bilateral cases it was logMAR 0.4 in group 1 and logMAR 0.2 in group 2 (p = 0.05). CONCLUSIONS: Leaving the peripheral lens capsule intact had no negative effect on the incidence of glaucoma and on resulting visual acuity.

Visual Outcomes after Primary Iris Claw Artisan Intraocular Lens Implantation during Complicated Cataract Surgery.

PURPOSE: To evaluate the efficacy and safety of aphakic Artisan-Verysise intraocular lens (IOL) primarily implanted for complicated cataract surgery. METHODS: A retrospective analysis of 49 eyes that underwent primary aphakic Artisan IOL implantation for complicated cataract surgery. Pre- and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalents (SE) were compared. RESULTS: The mean age of the participants was 68 ± 12.7 years, and the mean follow-up time was 30.7 ± 14.8 months. The mean BCVA improved significantly from 0.58 ± 0.4 at baseline to 0.44 ± 0.41 after the operation (P = 0.008). The spherical equivalent changed insignificantly from -0.13 ± 1.55 preoperatively to -0.6 ± 1.88 (P = 0.724) at the last visit. Postoperative complications were transient pigmented precipitates in five cases and raised intraocular pressure in one case. CONCLUSION: Aphakic Artisan IOLs are attractive alternatives in complicated cataract surgery without sufficient capsular bag support.

Difluprednate versus prednisolone acetate for inflammation following cataract surgery in pediatric patients: a randomized safety and efficacy study.

PurposeTo evaluate safety and efficacy of difluprednate 0.05% ophthalmic emulsion for treatment of postoperative inflammation after cataract surgery in pediatric patients.MethodsThis was a phase 3B, multicentre, randomized, double-masked, active-controlled study of patients aged 0-3 years who underwent uncomplicated cataract surgery in one eye, with/without intraocular lens implantation. Patients were randomized to receive difluprednate 0.05% four times daily or prednisolone acetate 1% for 14 days post surgery, followed by tapering for 14 days. Safety included evaluation of adverse events. Primary efficacy was the proportion of patients with an anterior cell grade of 0 (no cells) at day 14; secondary efficacy was a global inflammation score.ResultsForty patients were randomized to each treatment group. Adverse drug reactions included corneal oedema (difluprednate 0.5%, n=1; prednisolone acetate 1%, n=0) and increased intraocular pressure or ocular hypertension (n=2/group). Mean intraocular pressure values during treatment were 2-3 mm Hg higher with difluprednate 0.05% compared with prednisolone acetate 1%; mean values were similar between groups by the first week after treatment cessation. At 2 weeks post surgery, the incidence of complete clearing of anterior chamber cells was similar between groups (difluprednate 0.05%, n=30 (78.9%); prednisolone acetate 1%, n=31 (77.5%). Compared with prednisolone acetate 1%, approximately twice as many difluprednate 0.05%-treated patients had a global inflammation assessment score indicating no inflammation on day 1 (n=12 (30.8%) vs n=7 (17.5%) and day 8 (n=18 (48.7%) vs n=10 (25.0%).ConclusionsDifluprednate 0.05% four times daily showed safety and efficacy profiles similar to prednisolone acetate 1% four times daily in children 0-3 years undergoing cataract surgery.

Is an iris claw IOL a good option for correcting surgically induced aphakia in children? A review of the literature and illustrative case study.

Refractive correction of aphakia in childhood can be a complex management issue following lensectomy for congenital cataract or ectopia lentis. Some children have inadequate capsular support to allow an 'in the bag' or sulcus fixated intra-ocular lens (IOL). In such cases, options for refractive correction include spectacles, contact lenses, or surgically fixed IOLs. Many methods of IOL fixation have been described, but none are widely adopted in children. In recent years, the iris-fixated Artisan Aphakic IOL has gained popularity, but there is still significant concern about the rate of corneal endothelial cell loss and IOL de-enclavation. Here, we review the current literature on the use of iris-fixated IOLs in children, the published data on endothelial cell loss and de-enclavation rates. We present a case illustrating the significant improvements in quality of life, which can be seen in selected children, and also the rate of endothelial cell loss, which can be encountered after initial surgery, and a re-enclavation event. We make the case that until more data are available on normal endothelial cell decline in early childhood, in addition to age-specific rates of endothelial cell loss and de-enclavation rates following surgery, the use of iris-fixated IOLs in children will continue to be a moot point and is unlikely to be widely adopted.

Congenital cataract associated with persistent fetal vasculature: findings from IoLunder2.

PurposeTo describe the frequency, characteristics, and treatment outcome of persistent fetal vasculature (PFV) in children undergoing surgery for congenital and infantile cataract in the first 2 years of life.Patients and methodsObservational population-based cohort study with case identification through active surveillance and standardised data collection via a national clinical network, the British Isles Congenital Cataract Interest Group (BCCIG).ResultsThe IoLunder2 cohort comprises 246 children undergoing surgery for bilateral and unilateral congenital and infantile cataract in the first 2 years of life. A total of 58/246 (24%) children had PFV (%): overall, 46/95 (46%) with unilateral cataract, and 12/141 (8%) with bilateral disease. Anterior segment vascular remnants were more common in bilateral than unilateral disease (75 vs 11%, P=0.01). At 1 year after surgery, 20% of children with bilateral PFV and 24% with unilateral had achieved normal vision for age within the operated eye. The prevalence of post-operative glaucoma was 9% (of children with bilateral disease) and 4% (unilateral).ConclusionPFV is significantly more common than previously reported, and outcomes are comparable to that for congenital and infantile cataract overall.

Strabismus developing after unilateral and bilateral cataract surgery in children.

PurposeTo evaluate the prevalence and risk factors of strabismus in children undergoing surgery for unilateral or bilateral cataract with or without intraocular lens implantation.MethodsMedical records of pediatric patients were evaluated from 2000 to 2011. Children undergoing surgery for unilateral or bilateral cataract with at least 1 year of follow-up were included. Children with ocular trauma, prematurity, or co-existing systemic disorders were excluded. The following data were evaluated: strabismus pre- and post-operation; age at surgery; post-operative aphakia or pseudophakia; and visual acuity.ResultsNinety patients were included, 40% had unilateral and 60% had bilateral cataracts. Follow-up was on average 51 months (range: 12-130 months). Strabismus was found preoperatively in 34.4% children, and in 43.3% children at last follow-up. Strabismus developed in 46.2% of children who were orthotropic preoperatively, whereas 32.3% of children who had strabismus before surgery became orthotropic. Strabismus occurred after unilateral or bilateral cataract surgery in 63.9% and 29.6% children, respectively. At the last follow-up, strabismus was found in 46.7% of aphakic and 58.7% of pseudophakic children (P=0.283). Children who developed strabismus were generally operated at a younger age as compared with those without strabismus (mean of 25.9 vs 52.7 months, P<0.001). Final visual acuity was inversely correlated with prevalence of strabismus.ConclusionStrabismus is a frequent complication after cataract surgery in children. Risk factors include unilateral cases and young age at surgery. No correlation was found between prevalence of strabismus and use of intraocular lens. Strabismus was more common in children with poor final visual acuity.

Visual Rehabilitation in Pediatric Aphakia.

The management of childhood cataract begins at the initial contact with the family and typically extends far into the child's future. Decisions affecting long-term care and visual outcomes are often made in these initial preoperative encounters. Treatment will vary depending on whether the cataract is unilateral or bilateral and whether it is infantile onset or later. Thorough discussion of the treatment options is needed, especially with description of the life-long management issues for the child. Visual outcomes will vary, with the best visual acuity results being observed in older children with bilateral cataracts. Visual rehabilitation of children with unilateral cataract requires use of a contact lens or an intraocular lens (IOL) for the best result with a chance for binocularity. Only about 50% of eyes with unilateral infantile cataract will develop vision of better than 20/200. For bilateral cataracts, both contacts and IOLs can be used, as well as aphakic glasses. Excellent visual outcomes are typical unless glaucoma develops, which occurs in up to 30% of cases. Cataract surgery after 1 year of age is associated with substantially better visual outcomes. The use of an IOL is most commonly accepted and performed for cataract in one or both eyes after 1 year of age. Prior to 1 year of age, significantly more secondary surgical procedures are required to manage opacification of the optical axis with the use of an IOL compared with the use of surgery and contact lens correction. Amblyopia therapy for unilateral cataract needs be continuous from the time of surgery until at least 8 years of age. It is often difficult to perform this therapy over such a long time period, with compliance with less than 30% of prescribed time during infancy at 5 years after surgery.

Primary versus secondary IOL implantation following removal of infantile unilateral congenital cataract: outcomes after at least 5 years.

PURPOSE: To report outcomes after at least 5 years' follow-up of consecutive patients at a single center undergoing unilateral congenital cataract surgery during infancy with primary intraocular lens (IOL) implantation at the time of surgery or undergoing secondary IOL implantation later in childhood. METHODS: The medical records of pseudophakic children who received initial cataract surgery before 7 months of age were retrospectively reviewed. Children with acquired cataract, persistent fetal vasculature, congenital glaucoma, or follow-up of <5 years were excluded. RESULTS: Mean age at time of cataract surgery was 2.7 months in the primary group (n = 13) and 1.9 months in the secondary group (n = 13). Mean age at IOL implantation in the latter group was 4.9 ± 2.2 years. Mean age at final follow-up was 10.7 ± 4.2 years in the primary group and 8.7 ± 3.0 years in the secondary group. Glaucoma surgery was performed in 2 primary group eyes and 1 secondary group eye; it was medically controlled in 2 additional eyes of the latter group. One secondary group eye was diagnosed as glaucoma suspect. Visual axis opacification required surgery in 5 primary group eyes and 2 secondary group eyes before IOL implantation. Unplanned IOL exchange or removal for high myopia was required in 3 primary group eyes and 1 secondary group eye. Strabismus surgery was performed in 3 primary group eyes and 7 secondary group eyes. Median visual acuity at final follow-up was 20/150 in both groups. Refraction at last follow-up was -2.9 ± 3.3 D in the primary and -1.8 ± 2.5 D in the secondary group. CONCLUSIONS: Reoperations were common in both groups over long-term follow-up. Close monitoring for glaucoma is also needed in both groups.

Risk factors of persistent diplopia following secondary intraocular lens implantation in patients with sensory strabismus from uncorrected monocular aphakia.

PURPOSE: We aimed to compare clinical characteristics between diplopia-free and diplopia-persistent patients after successful strabismus surgery, when patients complained of diplopia following secondary intraocular lens (IOL) implantation after prolonged aphakia accompanied by sensory strabismus. METHODS: Retrospective review of medical records of patients who complained of diplopia following secondary IOL placement with sensory strabismus after prolonged uncorrected monocular aphakia from isolated ocular trauma was done. We classified patients into two groups according to persistency of diplopia, 6 months after successful strabismus surgery. Clinical characteristics were compared between groups. RESULTS: A total of 31 patients were included. The diplopia-persistent group showed longer duration of uncorrected aphakia (p = 0.02), less severe corneal astigmatism (p = 0.04), a smaller exodeviation angle (p = 0.02), and more frequent vertical deviation (p = 0.015), extorsion (p = 0.022) and monocular nystagmus (p = 0.028) than the diplopia-free group. In all patients in the diplopia-free group, diplopia could be eliminated prior to strabismus surgery using loose prisms in free space, whereas seven patients in the diplopia-persistent group prior to surgery could not resolve diplopia. CONCLUSIONS: Our data will be helpful for ocular surgeons in determining whether to insert secondary IOL in prolonged aphakia with sensory strabismus, or whether strabismus surgery will eliminate diplopia that develops following secondary IOL placement in this situation.