Secondary Intraocular Lens Implantation for Pediatric Aphakia

Purpose: We sought to report the outcome of secondary intraocular lens (IOL) implantation in children. Methods: This was a retrospective case review. Results: A total of 77 eyes were identified. An average age at secondary implantation was 7.8 ± 5.0 years, whereas the average age at primary cataract surgery was 1.5 ± 2.6 years. Average follow-up was 2.7 ± 1.9 years. Thirty eyes received a hydrophobic acrylic IOL implantation whereas 47 eyes received a PMMA IOL. The sites of fixation for implanted IOLs were as follows: anterior-chamber (n = 6), sulcus (n = 42), in-the-bag (n = 14), optic-capture (n = 6), piggyback (n = 4), and sutured (n = 5). Complications included clinically significant decentration, 4 (5.2%); visual axis opacification, 4 (5.2%); dislocation of the IOL, 2 (2.6%); and pupillary capture requiring repositioning of IOL, 1 (1.3%). Clinically significant decentration requiring surgical intervention was noted only in eyes with sulcus-fixated foldable IOLs (28.6%; 4/14). None of the 29 eyes with sulcus-fixated PMMA IOL implantation developed decentration. All the decentrations were in an inferior direction and occurred in eyes of male patients (P = 0.03). Eyes with an axial length of >23 mm were 4 times more likely to develop decentration if implanted with a sulcus-fixated foldable IOL when compared with eyes measuring <23 mm (P = 0.03). Postoperative geometric mean visual acuity was significantly better than preoperative visual acuity (P < 0.001). Conclusion: Secondary IOL implantation can be safely achieved in pediatric eyes. In-the-bag fixation of foldable IOLs is associated with a low rate of complications. Foldable lenses appear to have a higher rate of decentration than PMMA lenses when placed in the sulcus in eyes of myopic male patients.