The role and efficacy of secondary intraocular lenses in the treatment of monocular infantile cataracts.

Purpose: To determine if and when a secondary intraocular lens (IOL) can be beneficial to the successful treatment of a monocular infantile cataract.

Methods: This retrospective study reviewed medical records of children undergoing treatment of a monocular congenital cataract from 1996 to 2009 at one pediatric ophthalmology practice. Patients had unilateral cataracts removed by age 8 months and a secondary IOL inserted prior to 6 years of age. At the final visit, the children had to perform linear Snellen visual acuity testing.

Results: Of 11 identified patients, 8 had treatment onset by age 4 months and 3 between 5 and 7 months of age. These 3 children had final acuities of 20/500 (n=2) and hand motion (n=1). Those undergoing treatment prior to age 5 months had Snellen acuities of 20/30 to 20/400. The best results were obtained by patients who were compliant with contact lenses and patching before insertion of a secondary IOL.

Conclusions: If treatment of a monocular congenital cataract begins by 4 months of age (ie, the critical period for visual development) and patients remain compliant with occlusion therapy and an aphakic contact lens, then they will likely do well after IOL implantation. Furthermore, it appears that insertion of a secondary IOL will maintain vision that was established with a contact lens and patching and perhaps prevent deterioration that might still occur if compliance issues develop. However, secondary IOL placement will not dramatically improve the final visual result from that developed with occlusion and a contact lens.