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Scott R Lambert - One of the best experts on this subject based on the ideXlab platform.
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outcomes of secondary intraocular lens implantation in the infant Aphakia treatment study
Journal of Cataract and Refractive Surgery, 2021Co-Authors: Deborah K Vanderveen, Erick D Bothun, Edward M Wilson, Scott R Lambert, Azhar Nizam, Carolyn Drewsbotsch, Lorri B Wilson, Infant Aphakia Treatment StudyAbstract:Purpose To report outcomes of secondary intraocular lens (IOL) implantation in the Infant Aphakia Treatment Study (IATS) SETTING:: Multicenter clinical practice DESIGN:: Secondary analysis of patients enrolled in a randomized clinical trial METHODS:: Details regarding all secondary IOL surgeries conducted in children enrolled in the IATS were compiled. We evaluated visual outcomes, refractive outcomes, and adverse events at age 10 ½ years. Comparisons were made to eyes that remained aphakic and to eyes randomized to primary IOL placement. Results 55/57 patients randomized to Aphakia with contact lens correction were seen for the 10 ½ year study visit; 24/55 eyes (44%) had secondary IOL surgery. Median age at IOL surgery was 5.4 years (range 1.7 to 10.3 years). Mean absolute prediction error was 1.0 ± 0.7D. At age 10 ½ years, the median log MAR VA was 0.9 (range 0.2 to 1.7), similar to VA in the 31 eyes still aphakic (0.8, range 0.1 to 2.9); the number of eyes with stable or improved VA scores between the 4 ½ and 10 ½ year study visits was also similar (78% secondary IOL eyes, 84% aphakic eyes). For eyes undergoing IOL implantation after the 4.5 year study visit (n=22), the mean refraction at age 10 ½ years was -3.2 ±2.7D (range -9.9D to 1.1D), compared to -5.5 ±6.6 D (n=53, range -26.5 to 3.0D) in eyes with primary IOL (p=0.03). Conclusions Delayed IOL implantation allows a more predictable refractive outcome at age 10 ½ years, though the range of refractive error is still large.
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frefractive growth variability in the infant Aphakia treatment study
Journal of Cataract and Refractive Surgery, 2020Co-Authors: George Cotsonis, Azhar Nizam, Scott K Mcclatchey, Thaddeus S Mcclatchey, Scott R LambertAbstract:PURPOSE Prediction of refraction after cataract surgery in children is limited by the variance in rate of refractive growth (RRG3). This study compared RRG3 in aphakic and pseudophakic eyes to their fellow, normal eyes in the Infant Aphakia Treatment Study (IATS). SETTING 12 clinical sites in the United States. DESIGN Randomized clinical trial. METHODS Infants randomized to unilateral cataract extraction had RRG3 calculated based on biometric data (axial length and keratometry) at cataract surgery and at 10 years of age, for both the normal and cataract eyes. Subjects were included if complete biometric data from both eyes was available both at surgery and at 10 years. Variance in RRG3 was compared between the groups with Pitman's test for equality of variance between correlated samples. RESULTS Longitudinal biometric data was available for 103 of the 114 patients enrolled. RRG3 for normal eyes was -15.0 (3.0) D (reported as mean (standard deviation)), for aphakic eyes -17.7 (6.2) D, and for pseudophakic eyes -16.7 (6.2) D (P < 0.0001 for comparison of variances in RRG3 between normal and all operated eyes). Further analysis found differences in the variance in axial length growth (P < 0.0001) between operated and normal eyes; the variance in keratometry measurement change did not reach significance. CONCLUSIONS The standard deviation in the rate of refractive growth of normal eyes in our study is half of that found in eyes that underwent cataract surgery.
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the myopic shift in aphakic eyes in the infant Aphakia treatment study after 10 years of follow up
Eye & Contact Lens-science and Clinical Practice, 2020Co-Authors: Scott R Lambert, Azhar Nizam, Lindreth Dubois, George Cotsonis, David R Weakley, Edward M WilsonAbstract:Objectives To report the myopic shift in the aphakic eyes of a cohort of children who underwent unilateral cataract surgery during infancy and were then followed longitudinally for 10.5 years. Methods One-half of the children enrolled in the Infant Aphakia Treatment Study (IATS) were randomized to Aphakia and contact lens correction after unilateral cataract surgery. They then underwent ocular examinations using standardized protocols at prescribed time intervals until age 10.5 years. Results Thirty of 57 children randomized to Aphakia remained aphakic at age 10.5, having undergone unilateral cataract surgery at a median age of 1.6 (IQR: 1.1-3.1) months. The median refractive error (RE) in the 57 eyes randomized to Aphakia immediately after cataract surgery was 19.01 D (IQR: 16.98-20.49) compared to 10.38 D (IQR: 7.50-14.00) for the 30 eyes that remained aphakic at age 10.5 years. The mean change in RE in aphakic eyes was -2.11 D/year up to age 1.5 years, -0.68 D/year from 1.5 to 5.0 years, and -0.35 D/year from age 5 to 10.5 years. At age 10.5 years, 18 patients continued to wear a contact lens correction (silicone elastomer, n=6; gas permeable, n=6; hydrogel, n=5; and silicone hydrogel, n=1) (median RE, 12.50 D), 9 wore only spectacles (median RE, 4.00 D), and 4 wore no correction (median RE, 11.25 D) to correct their aphakic eye. Conclusions The RE in aphakic eyes decreased by 44% from infancy to age 10.5 years. About two-thirds of children who remained aphakic at age 10.5 years continued to wear a contact lens.
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association of contact lens adherence with visual outcome in the infant Aphakia treatment study a secondary analysis of a randomized clinical trial
JAMA Ophthalmology, 2018Co-Authors: Caroline H Cromelin, Buddy Russell, Carolyn Drewsbotsch, Scott R LambertAbstract:Importance Although contact lenses have been used for decades to optically correct eyes in children after cataract surgery, there has never been a prospective study looking at contact lens adherence in children with Aphakia, to our knowledge. Objective To evaluate contact lens adherence and its association with visual outcome in a cohort of children treated for unilateral cataract surgery. Design, Setting, and Participants Secondary analysis of a multicenter randomized clinical trial of 57 infants born from August 22, 2004, to April 25, 2008, who were randomized to 1 of 2 treatments and followed up to age 5 years. Data analysis was performed from August 9, 2016, to December 7, 2017. Interventions Unilateral cataract extraction and randomization to implantation of an intraocular lens vs contact lens to correct Aphakia. Main Outcomes and Measures Contact lens adherence was assessed by a 48-hour recall telephone interview that was administered every 3 months starting 3 months after surgery to age 5 years. A traveling examiner assessed visual acuity in patients at aged 4.5 years. Adherence to prescribed contact lens use was estimated as the mean percentage of waking hours as reported in 2 or more interviews for each year of life. Results Of 57 infants who were randomized to contact lens treatment, 32 (56%) were girls, and 49 (86%) were white. A total of 872 telephone interviews were completed. In year 1, a median of 95% participants wore their contacts lenses nearly all waking hours (interquartile range [IQR], 84%-100%); year 2, 93% (IQR, 85%-99%); year 3, 93% (IQR, 85%-99%); year 4, 93% (IQR, 75%-99%); and year 5, 89% (IQR, 71%-97%). There was a tendency for poorer reported adherence at older ages ( F = 3.86, P P = .08). Conclusions and Relevance These results confirm that it is possible to achieve a high level of aphakic contact lens adherence over a 5-year period in children. Trial Registration clinicaltrials.gov Identifier:NCT00212134
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the infant Aphakia treatment study contact lens experience to age 5 years
Eye & Contact Lens-science and Clinical Practice, 2017Co-Authors: Buddy Russell, Michael J Lynn, Lindreth Dubois, Michael A Ward, Scott R LambertAbstract:PURPOSE:To describe our experience treating a cohort of unilateral aphakic infants with contact lenses in the Infant Aphakia Treatment Study (IATS). MATERIALS AND METHODS:Fifty-seven of the 114 infants in the IATS were randomized to contact lens wear; all were followed until age 5 years, although a few had lapses in care. An examination under anesthesia, including keratometry, was performed at the time of enrollment and at approximately 1 year of age; keratometry was performed again at 5 years of age. A traveling examiner assessed visual acuity at approximately 1 year of age and again at 4.5 years of age. RESULTS:Twenty-four treated eyes (46%) wore silicone elastomer (SE) contact lenses, 11 eyes (19%) rigid gas permeable (GP) contact lenses and 17 eyes (29%) wore both lens types at various points of time. Median logMAR visual acuity was +0.70 (interquartile range (IQR), +0.30 to 1.20) in the SE group and 2.03 (IQR, +0.20 to 2.28) in the GP group at age 4.5 years. The mean (±SD) keratometric power of the treated eyes was 46.3±2.8 diopter (D) at baseline, 44.6±2.3 D at 1 year of age, and 44.3±1.7 D at 5 years of age. Keratometric astigmatism of treated eyes was 1.98±1.37 D at baseline, 1.62±0.98 D at 1 year of age, and 2.00±1.00 D at 5 years of age. Thirteen contact lens-related adverse events occurred among 7 patients after age 1 year. CONCLUSIONS:A cohort of infants with unilateral Aphakia successfully wore contact lenses with relatively few adverse events.
Edward M Wilson - One of the best experts on this subject based on the ideXlab platform.
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outcomes of secondary intraocular lens implantation in the infant Aphakia treatment study
Journal of Cataract and Refractive Surgery, 2021Co-Authors: Deborah K Vanderveen, Erick D Bothun, Edward M Wilson, Scott R Lambert, Azhar Nizam, Carolyn Drewsbotsch, Lorri B Wilson, Infant Aphakia Treatment StudyAbstract:Purpose To report outcomes of secondary intraocular lens (IOL) implantation in the Infant Aphakia Treatment Study (IATS) SETTING:: Multicenter clinical practice DESIGN:: Secondary analysis of patients enrolled in a randomized clinical trial METHODS:: Details regarding all secondary IOL surgeries conducted in children enrolled in the IATS were compiled. We evaluated visual outcomes, refractive outcomes, and adverse events at age 10 ½ years. Comparisons were made to eyes that remained aphakic and to eyes randomized to primary IOL placement. Results 55/57 patients randomized to Aphakia with contact lens correction were seen for the 10 ½ year study visit; 24/55 eyes (44%) had secondary IOL surgery. Median age at IOL surgery was 5.4 years (range 1.7 to 10.3 years). Mean absolute prediction error was 1.0 ± 0.7D. At age 10 ½ years, the median log MAR VA was 0.9 (range 0.2 to 1.7), similar to VA in the 31 eyes still aphakic (0.8, range 0.1 to 2.9); the number of eyes with stable or improved VA scores between the 4 ½ and 10 ½ year study visits was also similar (78% secondary IOL eyes, 84% aphakic eyes). For eyes undergoing IOL implantation after the 4.5 year study visit (n=22), the mean refraction at age 10 ½ years was -3.2 ±2.7D (range -9.9D to 1.1D), compared to -5.5 ±6.6 D (n=53, range -26.5 to 3.0D) in eyes with primary IOL (p=0.03). Conclusions Delayed IOL implantation allows a more predictable refractive outcome at age 10 ½ years, though the range of refractive error is still large.
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the myopic shift in aphakic eyes in the infant Aphakia treatment study after 10 years of follow up
Eye & Contact Lens-science and Clinical Practice, 2020Co-Authors: Scott R Lambert, Azhar Nizam, Lindreth Dubois, George Cotsonis, David R Weakley, Edward M WilsonAbstract:Objectives To report the myopic shift in the aphakic eyes of a cohort of children who underwent unilateral cataract surgery during infancy and were then followed longitudinally for 10.5 years. Methods One-half of the children enrolled in the Infant Aphakia Treatment Study (IATS) were randomized to Aphakia and contact lens correction after unilateral cataract surgery. They then underwent ocular examinations using standardized protocols at prescribed time intervals until age 10.5 years. Results Thirty of 57 children randomized to Aphakia remained aphakic at age 10.5, having undergone unilateral cataract surgery at a median age of 1.6 (IQR: 1.1-3.1) months. The median refractive error (RE) in the 57 eyes randomized to Aphakia immediately after cataract surgery was 19.01 D (IQR: 16.98-20.49) compared to 10.38 D (IQR: 7.50-14.00) for the 30 eyes that remained aphakic at age 10.5 years. The mean change in RE in aphakic eyes was -2.11 D/year up to age 1.5 years, -0.68 D/year from 1.5 to 5.0 years, and -0.35 D/year from age 5 to 10.5 years. At age 10.5 years, 18 patients continued to wear a contact lens correction (silicone elastomer, n=6; gas permeable, n=6; hydrogel, n=5; and silicone hydrogel, n=1) (median RE, 12.50 D), 9 wore only spectacles (median RE, 4.00 D), and 4 wore no correction (median RE, 11.25 D) to correct their aphakic eye. Conclusions The RE in aphakic eyes decreased by 44% from infancy to age 10.5 years. About two-thirds of children who remained aphakic at age 10.5 years continued to wear a contact lens.
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outcomes of bilateral cataracts removed in infants 1 to 7 months of age using the toddler Aphakia and pseudophakia treatment study registry
Ophthalmology, 2020Co-Authors: Rupal H. Trivedi, David A Plager, Sharon F Freedman, Erick D Bothun, Edward M Wilson, Deborah K Vanderveen, Elias I Traboulsi, Jill S Anderson, Allison R LohAbstract:Purpose This study evaluates outcomes of bilateral cataract surgery in infants ages 1 to 7 months performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and compares them to IATS outcomes of unilateral cases. Design Retrospective case series review at 10 IATS sites. Participants The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS. Intervention Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years of 2004 through 2010. Main Outcome Measures Visual acuity, strabismus, adverse events (AE), reoperations. Results 178 eyes (96 children) were identified with a median age of 2.5 months (range 1-7) at cataract surgery. 42 (24%) eyes received primary intraocular lens (IOL) implantation. Median visual acuity of the better-seeing eye at final study visit closest to age 5 years with optotype visual acuity (VA) testing was 0.35 logMAR (20/45) (range, 0.00 – 1.18) in both aphakic and pseudophakic children. Corrected visual acuity was excellent ( > 20/200) in the better-seeing eye and 12% in the worse-seeing eye. Younger age at surgery and smaller ( Conclusions Visual acuity after bilateral cataract surgery in infants younger than 7 months is good despite frequent systemic and ocular co-morbidities. Although Aphakia management did not affect visual acuity outcome or AE, IOL placement increased the risk of visual axis opacification. AE and glaucoma correlated with a younger age at surgery and glaucoma with the presence of microcornea.
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comparison of the rate of refractive growth in aphakic eyes versus pseudophakic eyes in the infant Aphakia treatment study
Journal of Cataract and Refractive Surgery, 2016Co-Authors: Scott R Lambert, David A Plager, Edward M Wilson, Lindreth Dubois, George Cotsonis, Edward G Buckley, Scott K McclatcheyAbstract:Purpose To compare the rate of refractive growth (RRG) between aphakic eyes and pseudophakic eyes in the Infant Aphakia Treatment Study (IATS). Setting Twelve clinical sites across the United States. Design Randomized clinical trial. Methods Patients randomized to unilateral cataract extraction with contact lens correction versus intraocular lens (IOL) implantation in the IATS had their rate of refractive growth (RRG3) calculated based on the change in refraction from the 1-month postoperative examination to age 5 years. The RRG3 is a logarithmic formula designed to calculate the RRG in children. Two-group t tests were used to compare the mean refractive growth between the contact lens group and IOL group and outcomes based on age at surgery and visual acuity. Results Longitudinal refractive data were studied for 108 of 114 patients enrolled in the IATS (contact lens group, n = 54; IOL group, n = 54). The mean RRG3 was similar in the contact lens group (−18.0 diopter [D] ± 11.0 [SD]) and the IOL group (−19.0 ± 9.0 D) ( P = .49). The RRG3 value was not correlated with age at cataract surgery, glaucoma status, or visual outcome in the IOL group. In the Aphakia group, only visual outcome was correlated with refractive growth ( P = .01). Conclusions Infants' eyes had a similar rate of refractive growth after unilateral cataract surgery whether or not an IOL was implanted. A worse visual outcome was associated with a higher RRG in aphakic, but not pseudophakic, eyes. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.
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comparison of contact lens and intraocular lens correction of monocular Aphakia during infancy a randomized clinical trial of hotv optotype acuity at age 4 5 years and clinical findings at age 5 years
JAMA Ophthalmology, 2014Co-Authors: Scott R Lambert, David A Plager, Sharon F Freedman, Lindreth Dubois, Carolyn Drewsbotsch, Edward G Buckley, Michael J Lynn, Eugenie E Hartmann, Edward M WilsonAbstract:Importance The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. Objective To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. Design, Setting, and Participants The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. Interventions Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct Aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. Main Outcomes and Measures HOTV optotype visual acuity at 4.5 years of age. Results The median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group ( P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P Conclusions and Relevance There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected Aphakia. Trial Registration clinicaltrials.gov Identifier:NCT00212134
Sharon F Freedman - One of the best experts on this subject based on the ideXlab platform.
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outcomes of bilateral cataracts removed in infants 1 to 7 months of age using the toddler Aphakia and pseudophakia treatment study registry
Ophthalmology, 2020Co-Authors: Rupal H. Trivedi, David A Plager, Sharon F Freedman, Erick D Bothun, Edward M Wilson, Deborah K Vanderveen, Elias I Traboulsi, Jill S Anderson, Allison R LohAbstract:Purpose This study evaluates outcomes of bilateral cataract surgery in infants ages 1 to 7 months performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and compares them to IATS outcomes of unilateral cases. Design Retrospective case series review at 10 IATS sites. Participants The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS. Intervention Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years of 2004 through 2010. Main Outcome Measures Visual acuity, strabismus, adverse events (AE), reoperations. Results 178 eyes (96 children) were identified with a median age of 2.5 months (range 1-7) at cataract surgery. 42 (24%) eyes received primary intraocular lens (IOL) implantation. Median visual acuity of the better-seeing eye at final study visit closest to age 5 years with optotype visual acuity (VA) testing was 0.35 logMAR (20/45) (range, 0.00 – 1.18) in both aphakic and pseudophakic children. Corrected visual acuity was excellent ( > 20/200) in the better-seeing eye and 12% in the worse-seeing eye. Younger age at surgery and smaller ( Conclusions Visual acuity after bilateral cataract surgery in infants younger than 7 months is good despite frequent systemic and ocular co-morbidities. Although Aphakia management did not affect visual acuity outcome or AE, IOL placement increased the risk of visual axis opacification. AE and glaucoma correlated with a younger age at surgery and glaucoma with the presence of microcornea.
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corneal changes in children after unilateral cataract surgery in the infant Aphakia treatment study
Ophthalmology, 2015Co-Authors: David G Morrison, Sharon F Freedman, Michael J Lynn, Faruk H Orge, Scott R LambertAbstract:Purpose We report endothelial cell (EC) characteristics and central corneal thickness (CCT) from the Infant Aphakia Treatment Study (IATS) patients at the 5-year examination. Design Randomized, controlled trial of the treatment of unilateral cataract with aphakic contact lens (CL) versus primary intraocular lens (IOL) implant. Participants A total of 114 infants with unilateral cataract. Methods The EC density, coefficient of variation (CV), and percent hexagonal cells were measured by noncontact specular microscopy. The CCT was measured using contact pachymetry. Fellow eyes served as controls. Main Outcome Measures Mean differences between treated and fellow eyes of CL and IOL groups were compared with a paired t test. A 1-way analysis of variance model and the Tukey–Kramer multiple comparison procedure were used to assess the effect of a diagnosis of glaucoma or glaucoma suspect. Results A total of 105 subjects (52 with CLs, 53 with IOLs) had specular microscopy or corneal thickness data recorded. Mean EC densities were higher in aphakic eyes compared with fellow eyes (3921 vs. 3495 cells/mm 2 , P P = 0.0002) and mean percent hexagonal cells was lower (72% vs. 76%, P = 0.002) in aphakic eyes compared with fellow eyes. Mean CCT of aphakic eyes was higher than in controls (637 vs. 563 μm, P 2 , P = 0.68). Means for CV (25 vs. 24, P = 0.07) and percent hexagonal cells (74 vs. 76%, P = 0.27) were also not significantly different. Mean CCT was higher in eyes with IOLs (605 vs. 571 μm, P 2 , P = 0.03) and treated eyes with glaucoma suspect had greater mean corneal thickness (660 vs. 612 μm, P = 0.0036). Conclusions Cataract extraction during infancy with IOL implantation was not associated with a reduced EC count in treated compared with fellow eyes, although CCT was increased. Extended-wear aphakic CLs may cause corneal polymegathism with increased EC density and CCT. Glaucoma diagnosis was associated with reduced EC counts and increased CCT.
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comparison of contact lens and intraocular lens correction of monocular Aphakia during infancy a randomized clinical trial of hotv optotype acuity at age 4 5 years and clinical findings at age 5 years
JAMA Ophthalmology, 2014Co-Authors: Scott R Lambert, David A Plager, Sharon F Freedman, Lindreth Dubois, Carolyn Drewsbotsch, Edward G Buckley, Michael J Lynn, Eugenie E Hartmann, Edward M WilsonAbstract:Importance The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. Objective To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. Design, Setting, and Participants The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. Interventions Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct Aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. Main Outcomes and Measures HOTV optotype visual acuity at 4.5 years of age. Results The median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group ( P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P Conclusions and Relevance There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected Aphakia. Trial Registration clinicaltrials.gov Identifier:NCT00212134
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glaucoma related adverse events in the infant Aphakia treatment study 1 year results
Archives of Ophthalmology, 2012Co-Authors: Allen D Beck, Sharon F Freedman, Erick D Bothun, Michael J Lynn, Daniel E Neely, Scott R LambertAbstract:Glaucoma is an important complication of pediatric cataract surgery, with a wide range of reported frequencies, depending on the definition used and the length of follow-up 1-3. Two large, retrospective series reported 15-21% frequency of glaucoma diagnosed 5 years after cataract surgery 4-5. Numerous risk factors for the development of glaucoma have been noted, including cataract surgery in the first year of life, postoperative complications such as secondary membrane surgery, small corneal diameters, type of cataract, a family history of aphakic glaucoma, and primary posterior capsulotomy/anterior vitrectomy performed at the time of cataract surgery 2-10. Cataract surgery in the first year of life, and small corneal diameters have been the most consistent risk factors for glaucoma development in reported studies 3,5-10. The effect of the placement of an intraocular lens (IOL) at the time of cataract surgery on the risk of developing glaucoma is unknown, although one retrospective review suggested a decreased incidence of glaucoma in patients who received an IOL 11. However the eyes which received an IOL in that report were older at the time of surgery (mean age 5.1 years for pseudophakia versus 2.7 years for Aphakia) and children with corneal diameters less than or equal to 10 mm were excluded from analysis. Other studies have noted similar rates of glaucoma in aphakic and pseudophakic children who had cataract surgery performed in the first year of life 9,10. The Infant Aphakia Treatment Study (IATS) is a multi-center, randomized, controlled clinical trial sponsored by the National Eye Institute. The objective of the study is to compare the use of primary IOL implantation to surgery without IOL implantation in infants with a unilateral congenital cataract removed between 1 and 6 months of age. The results of IATS during the first year after cataract surgery including visual acuity, adverse events, and additional surgery have been previously reported 12. In this paper we report the development of glaucoma-related adverse events in IATS subjects through 1 year of follow-up.
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central corneal thickness congenital cataracts and Aphakia
American Journal of Ophthalmology, 2007Co-Authors: Kelly W Muir, Lois Duncan, Laura B Enyedi, David K Wallace, Sharon F FreedmanAbstract:Purpose To evaluate central corneal thickness (CCT) in normal children (controls) and in those with cataracts, pseudophakia, and Aphakia. Design Prospective, observational case series. Methods CCT was measured in 369 eyes of 223 children. Subjects with glaucoma, anterior segment abnormalities, or intraocular pressure of more than 30 mm Hg were excluded. Group means were compared for controls and for eyes with pediatric cataracts, pseudophakia, and Aphakia. Results The mean CCT of eyes with cataracts was more than that of controls (574 ± 54 μm [n = 46] and 552 ± 38 μm [n = 230], respectively; P = .001). After excluding from the cataract group those eyes with aniridia, Down syndrome, Marfan syndrome, or glaucoma surgery, the mean CCT (564 ± 34 μm [n = 36]) was no longer greater than that of controls ( P = .07). The mean CCT of pseudophakic eyes (598 ± 56 μm [n = 29]) was greater than the mean CCT of controls ( P P = .06). The mean CCT of aphakic eyes (642 ± 88 μm [n = 64]) was greater than the mean CCT of controls ( P P P = .003). Conclusions In the absence of factors known to affect CCT (Down syndrome, Marfan syndrome, and aniridia), CCT is similar in eyes with pediatric cataracts and normal controls and increases after cataract surgery.
Evrim Polat - One of the best experts on this subject based on the ideXlab platform.
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secondary iris claw intraocular lens implantation for the correction of Aphakia after pars plana vitrectomy
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Nur Acar, Ziya Kapran, Tugrul Altan, Yasar Kucuksumer, Yaprak Banu Unver, Evrim PolatAbstract:PURPOSE: The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens implantation for correction of Aphakia in vitrectomized eyes without capsular support. METHODS: This was a prospective interventional case series. Twelve aphakic vitrectomized eyes without capsular support underwent iris claw intraocular lens implantation. The main outcome measures were changes in uncorrected visual acuity, best-corrected visual acuity, spheric equivalent, corneal endothelial cell density, corneal thickness, central macular thickness, and complications. RESULTS: Mean follow-up was 15.58 +/- 3.80 months with no intraoperative complications. Postoperatively, uncorrected visual acuity increased significantly at all follow-up visits (P 0.05). No corneal edema was observed. Complications were transient intraocular pressure increase (n = 1), cystoid macular edema (n = 1), and haptic dislocation replaced by surgery (n = 1). Retinas remained attached in all eyes. CONCLUSION: Secondary iris claw intraocular lens implantation is clinically safe and effective to correct Aphakia in vitrectomized eyes without capsular support. Larger studies with longer follow-up are warranted.
Mario Damiano Toro - One of the best experts on this subject based on the ideXlab platform.
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five year follow up of secondary iris claw intraocular lens implantation for the treatment of Aphakia anterior chamber versus retropupillary implantation
PLOS ONE, 2019Co-Authors: Mario Damiano Toro, Antonio Longo, Teresio Avitabile, Katarzyna Nowomiejska, Caterina Gagliano, Sarah Tripodi, Tomasz Choragiewicz, Agnieszka Kaminska, Michele FigusAbstract:BACKGROUND Though several procedures of IOL implantation have been described (sutured scleral fixation, intra-scleral fixation, angle-supported anterior chamber, and anterior chamber or retropupillary iris-claw IOLs), there are no randomized trials which are comparing different techniques. Hence, the surgical treatment of Aphakia still remains controversial and challenging. The purpose of this study was to compare the long-term efficacy and the rate of complications of anterior versus posterior Iris-claw intraocular lenses (IOL) implantation to correct for the treatment of Aphakia without sufficient capsule support. METHODS AND FINDINGS Consecutive eyes having secondary implantation of aphakic iris-fixated IOLs with a follow-up of at least 5 years were considered. Mean correct distance visual acuity (CDVA) changes, percentage of eyes with CDVA improvement, mean corneal endothelial cell density (CECD) loss and the rate of other complications were used for statistical analysis. The study evaluated a total of 180 eyes (Group A: 87 anterior chamber iris-claw fixation, Group B: 93 retropupillary iris-claw implantation) of 180 consecutive different patients, with Aphakia of various reasons. CDVA improved significantly in both groups after surgery (P<0.001, ANOVA), and was remarkably higher than baseline in both groups from first week and during the entire follow-up (P<0.001, Tukey's Honest Significant Difference). There was no statistically significant difference in CDVA between the two groups during each follow-up visits (P = NS, unpaired t-test) and in the CDVA improvement percentage between the two groups (P = 0.882, Chi-square test). No significant changes in CECD were noted after surgery in both groups (ANOVA Group A: P = 0.067, Group B: P = 0.330P). No intra-operative complications occurred in both groups. There was no statistically significant difference in the rate of complications between the two groups (P = NS, Chi-square test), except for pigment precipitates which were higher in Group A (P<0.05, Chi-square test). CONCLUSIONS Five-year follow-up shows that secondary implantation of aphakic IOLs is effective and safe for the correction treatment of Aphakia in eyes without capsule support.