Unilateral intraocular lens implantation during the first six months of life

Purpose: The purpose of this study was to determine the incidence of postoperative complications and the occurrence of myopic shift in infantile eyes after cataract surgery and implantation of an intraocular lens (IOL). Methods: Cataract surgery and IOL implantation was performed on 11 infants with unilateral congenital cataracts who had a mean age of 10 ± 6 weeks at 5 clinical centers. IOLs with a mean power of 26.2 ± 2.3 D were implanted using a standardized protocol. The infants were then followed up for a mean of 13 ± 6 months for postoperative complications and longitudinal changes in their refractive error. Results: Eight of the 11 eyes had postoperative complications and were treated with a reoperation. Complications included open-angle glaucoma (n = 2), lens reproliferation into the visual axis (n = 2), pupillary membranes (n = 2), and corectopia (n = 2). A younger age at the time of surgery was positively correlated with the development of a postoperative complication requiring a reoperation ( P = .03). A mean myopic shift of 5.49 D occurred in these eyes a year after surgery. No preoperative factors could be identified that correlated with the magnitude of the myopic shift. Conclusion: IOL implantation during infancy is associated with a high complication rate frequently requiring reoperation. A large myopic shift typically occurs that necessitates an initial or a late overcorrection with spectacles or a contact lens, depending on the power of the IOL implanted. Until ongoing randomized trials are completed, we recommend that surgeons exercise caution before implanting IOLs in the eyes of infants. (J AAPOS 1999;3:344-9)