Abstract

P 087

Prospective comparative study of primary Acrysof IOL implantation versus aphakic contact lens correction in pediatric patients after unilateral congenital cataract extraction in the first 2 years of life

Pyrochtová S., Autrata R., Helmanová I., Řehůřek J.
Department of Pediatric Ophthalmology, Masaryk University Hospital, Brno, Czech Republic

Objective: To evaluate a role of foldable AcrySof intraocular lenses (IOLs) in pediatric eyes with unilateral congenital and developmental cataract. The study compared visual acuity, ocular alignment, the prevalence and severity of posterior capsule opacification (PCO), retreatment rate and binocular vision outcomes in two groups of pediatric patients: 1) pseudophakic and 2) aphakic with contact lens correction.
Methods: This prospective randomized study included 69 eyes of 69 children with a unilateral congenital cataract extraction with posterior capsulorhexis and anterior vitrectomy. Eyes were randomly assigned to be operated with (IOL group, n=33) primary AcrySof(Alcon) IOL implantation or without (CL group, n=36). All infants undergone the first surgery during 24 months of their life and they were operated in the period from 1994 to 2002. The mean age at surgery was 11.2±5.65 months (1 - 24). All patients were prescribed the same half-time reduced occlusion therapy. In the period from 2005 to 2007, the final visual acuity and binocular vision outcomes were examined. Analysis of variance, Kruskal-Wallis and Fisher exact tests were used to to evaluate mean differences between groups.
Results: The mean final visual acuity (LogMAR) was 0.41±0.35 for the IOL group and 0.78±0.31 for the CL group (P=.034). The mean interocular difference in visual acuity was 0.21 ± 0.27 for the IOL group and 0.64±0.31 for the CL group (P=.042). The reoperation rate was 41% in the IOL group compared with 35% in the CL group (P=.17). Esotropia or exotropia more than 8 prism diopters (PD) were present at 54% of children (18 from 33) in the IOL group compared with 80% of children (29 from 36 ) in the CL group (P=0.035). No statistically significant differences in PCO rate between the both groups.
Conclusions: Correction of aphakia after unilateral congenital cataract extraction with primary AcrySof IOL implantation resulted in significantly improved visual acuity, binocular vision outcome and less occurence of ocular missalignment, than correction with contact lenses.

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