Solebo, AO; (2012) National study of primary intraocular lens implantation in children ≤2 years old with congenital and infantile cataract. Doctoral thesis , UCL (University College London).

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Abstract

Cataract is a potentially reversible cause of childhood blindness which is responsible for at least 15% of the world’s blind children. Primary intraocular lens (IOL) implantation is the most important recent innovation in the management of childhood cataract, and has been widely adopted despite unanswered questions regarding best practice, visual benefits and adverse outcomes. In order to answer these questions, an epidemiological study was undertaken through systematic, standardised data collection through a national clinical network, the British Isles Congenital Cataract Interest Group. At the time of submitting this thesis, data are available for 236 children. IOL implantation was undertaken in the majority of children over 6 months old, but aphakia was the preferred option for younger children, due in part to the higher than anticipated frequency of other ocular anomalies. Overall primary IOL implantation conferred no visual benefit for children with unilateral cataract, but may be associated with better visual outcome following bilateral cataract surgery, whilst increasing the risk of the need for further surgical procedures under general anaesthetic, which may adversely impact on future cognitive development. 16% of all children developed glaucoma during the first postoperative year with age at surgery being the most significant factor. The potential eventual burden of aphakic and pseudophakic glaucoma is considerable, and these findings should encourage debate about the balance between the risk of amblyopia and the risk of glaucoma, as well as future research on this blinding complication Refractive planning and outcome in early life pseudophakia is highly variable. There is a pressing need for standardisation of refractive planning and continuous national monitoring of refractive outcomes, similar to that which exists in adult cataract surgical practice. Follow up studies of this unique inception cohort will provide further information on longer term outcomes and their impact on educational and personal development.

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