[Comparison of effects of secondary in-the-bag and sulcus intraocular lens implantation in pediatric aphakia after congenital cataract operation].

ABSTRACT

OBJECTIVE: To compare the results of secondary in-the-bag intraocular lens (IOL) implantation with secondary sulcus IOL implantation in the eyes which received cataract extraction during early infancy. METHODS: A case control study. We selected 60 eyes of 44 patients with pediatric aphakia that meet the inclusion criterion in Affiliated Eye Hospital of Wenzhou Medical College from September 2005 to August, 2011. Thirty eyes received in-the-bag secondary IOL implantation and were compared with 30 eyes that received secondary sulcus IOL implantation. Data were collected for the ages at cataract extraction and at secondary IOL implantation, the preoperative axial length, the length of follow-up, postoperative complications, postoperative best-corrected visual acuity (BCVA) and refraction. When sufficient capsular opening was possible or capsular support deemed adequate, an IOL was placed within the capsular bag, otherwise the IOL was implanted in the sulcus. The χ(2) test or Fisher exact test was used to compare complications between the in-the-bag and sulcus groups. The independent-samples t test or Wilcoxon rank sum test was used to compare demographic, preoperative and postoperative refractive relevant data between the in-the-bag and sulcus groups. RESULTS: The median of 1-week-postoperative spherical equivalent clustered 1.00 D (range, -2.13 to 3.38 D) for in-the-bag group and 0.69 D (range, -2.25 to 2.38 D) for the sulcus group (Z = -1.01, P = 0.31). The median of 1-year-postoperative spherical equivalent clustered 0.00 D (range, -3.50 to 3.00 D) for in-the-bag and -0.50 D (range, -3.25 to 2.50 D) for the sulcus (Z = -0.53, P = 0.60). The last follow-up BCVA was available in 23 of 30 eyes in the in-the-bag group and 22 of 30 eyes in the sulcus group. The median of visual outcome clustered around 0.20 D (range, 0.05 to 0.70 D) for in-the-bag and 0.20 D (range, 0.05 to 0.60 D) for the sulcus (Z = -1.06, P = 0.29). The rate of nystagmus was significantly greater in the sulcus group (63.3%) than in the in-the-bag group (33.3%) (χ(2) = 5.41, P = 0.02). The incidence of strabismus, glaucoma and corneal calcific band keratopathy in the in-the-bag group were 36.7% (11/30), 3.0% (1/30) and 10.0% (3/30); 23.3% (7/30), 3.0% (1/30) and 13.3% (4/30) in the sulcus group, respectively. There were no significant differences between the two groups (Strabismus χ(2) = 1.27, P = 0.26; Glaucoma χ(2) = 0.16, P = 0.69; corneal calcific band keratopathy P = 1.00). CONCLUSIONS: For children who have been aphakic due to receiving cataract extraction during their early infancy, there was no significant difference in both postoperative complications and visual acuity between the secondary in-the-bag IOL implantation and secondary sulcus IOL implantation during 1 year to 6 years follow-up time after the implantation surgery.