Recently, researchers have noted that secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk, according to a study published in the Eye Journal.
In recent years primary IOL implantation is fast becoming the preferred modality of treatment for most children older than two years of age. It has been extensively used with favorable results in children older than two years. In contrast, IOL implantation as a modality of aphakic correction in an infantile eye is debatable. Prime among the problems of primary IOL implantation in infants includes difficulty in selecting the appropriate diopteric power of the IOL. In addition, the small dimension of the infant's eye with a small capsular bag, decreased scleral rigidity, and increased tissue reactivity leading to excessive postoperative inflammation, make IOL implantation technically more difficult in these patients.
Hence, Peter J Ness and colleagues from the Medical University of South Carolina carried out this study to compare intraocular pressure (IOP) control before and during the first year after secondary intraocular lens (IOL) implantation in children.
The authors conducted a retrospective chart review of children who received secondary IOL implantation. A total of 100 eyes were included. The mean duration of follow-up was 7.74 months (SD = 3.11). IOP and antiglaucoma medications before and after implantation were analyzed. The latest exam with IOP measurement found within the 2-15 month period after IOL implantation was used for the postoperative data. Failure to maintain IOP control was defined as either the addition of antiglaucoma medication(s) or a rise in IOP > 4 mm Hg. Statistical analyses were performed to assess risk factors for failure to control IOP after surgery, namely age at IOL implantation, preoperative glaucoma status, and IOL fixation location.
The following findings were drawn-
a. Twenty-three of one hundred eyes failed to maintain IOP control according to our definition.
b. Eyes with a history of having had a traumatic cataract (n = 3) had a more than threefold increased risk of failure (P = 0.015).
c. Although not statistically significant, very young age at initial cataract surgery (<2 months old) had a twofold increased risk of failure compared to an older age (>12 months old) (P = 0.213).
d. No other risk factors were found to have statistical significance.
Therefore, it was concluded that "secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk."