Timing of secondary IOL linked to glaucoma risk but not vision in pediatric cataracts
In children with bilateral aphakia after early-onset (before age 2) cataract surgery, secondary intraocular lens (IOLs) implantation between ages 2 and 6 results in similar visual acuity outcomes, but the risk of developing glaucoma increases significantly with later implantation age, according to a study.
The study, conducted at a single center between 2014 and 2023, followed 158 children who underwent lensectomy before the age of 2 and subsequently received secondary IOL implantation between the ages of 2 and 6. Participants were grouped by the age at which they received their secondary IOL (2 to <3 years, 3 to <4 years, 4 to <5 years, and 5 to <6 years) and monitored them through age 7.
Across the age groups, best-corrected visual acuity (BCVA) at age 7 did not differ significantly. Mean BCVA ranged from 20/62 in children implanted between ages 2 and 3, to 20/89 in those implanted between ages 5 and 6 (P = 0.20). However, the incidence of glaucoma-related complications rose with later implantation. Only 8.8% of eyes in the youngest group experienced glaucoma-related events, compared with 22.6% in the oldest group (P = 0.03).
The authors concluded that secondary IOL implantation between the ages of 2 and 6 can provide similar visual outcomes, but earlier implantation may help reduce glaucoma risk.
Reference
Hu K, Zhang Y, Chen W, et al. Visual Acuity and Complications at Age 7 Years Following Bilateral Secondary Intraocular Lens Implantation at 2 to Younger Than 6 Years for Pediatric Aphakia. JAMA Ophthalmol. 2025;doi: 10.1001/jamaophthalmol.2025.1080. Epub ahead of print. PMID: 40372731.
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