Phacoemulsification and primary implantation with bag-in-the-lens intraocular lens in children with unilateral and bilateral cataract

PurposeTo report outcome in a paediatric cohort with cataract extraction and implantation of bag-in-the-lens intraocular lens (BIL-IOL). MethodsChildren younger than 16years of age subjected to phacoemulsification with primary implantation of BIL-IOL during 2009 through 2013 were analysed retrospectively. Exclusion criteria were uveitis or 6months of follow-up. ResultsIn total, 109 eyes of 84 children were included; 40 unilateral and 44 bilateral cataracts. For all eyes, median age at surgery was 2.5years (range 2weeks to 14.1years) and 16 children (24 eyes) were 6weeks. Coexisting systemic disease was more common in children with bilateral cataract (24 patients, 54.5%) compared to unilateral cataract (6 patients, 15.0%, p<0.0001). Ocular comorbidity was more common in unilateral cataracts; n=14 eyes (35.0%) compared to bilateral cataracts; n=10 eyes (14.5%; p=0.017). Median follow-up was 2.8years (range 7months to 5.8years). During the follow-up period, 15 (13.8%) eyes developed glaucoma and five (4.6%) eyes required treatment for visual axis opacification (VAO). Corrected distance visual acuity (CDVA) for bilateral cataracts at last follow-up was 0.420.45 (logMAR; mean +/- SD) with 35 (55.6%) eyes attaining a CDVA of 0.5 (dec). For unilateral cataracts mean CDVA was significantly poorer; 0.67 +/- 0.51 (p=0.010) with 15 (37.5%) eyes attaining a CDVA of 0.5. ConclusionFor children having cataract surgery with primary implantation of BIL-IOL, VAO is rare and visual outcome overall good. Unilateral cataracts are associated with a higher proportion of ocular comorbidity and poorer visual outcome.