Purpose

Appropriate correction of aphakia is key to good outcomes. There may be clinical settings where and populations in whom accessing or managing aphakic contact lenses is challenging. Strategies to target the increased risk of visual axis opacity (VAO) after primary intraocular lens (IOL) implantation in infancy are necessary. We describe the predictors of VAO after primary IOL implantation for unilateral or bilateral congenital or infantile cataract in children younger than 2 years of age.

Design

Population-based (United Kingdom and Ireland), prospective, inception cohort study undertaken through a national clinical network.

Participants

A total of 105 children (57 with bilateral cataract, 48 with unilateral cataract, total 162 eyes) undergoing primary IOL implantation in the first 2 years of life between January 2009 and December 2010.

Methods

Observational longitudinal study with multilevel, multivariable modeling to investigate associations between outcome of interest and child- and treatment-specific factors, including age, axial length, socioeconomic status, IOL model, and postoperative steroid use.

Main Outcome Measures

Postoperative proliferative or inflammatory visual axis opacity (VAO) requiring surgical correction.

Results

Visual axis opacity occurred in 67 eyes (45%), typically within the first postoperative year. Use of a 3-piece IOL model (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.09–0.99, P = 0.03) and increasing age at surgery (OR, 0.97, 95% CI, 0.95–0.99, P = 0.02) were each independently protective against the development of proliferative VAO. Inflammatory VAO was independently associated with socioeconomic deprivation (OR, 5.39; 95% CI, 1.46–19.89; P = 0.01).

Conclusions

Visual axis opacification is common after IOL implantation in early childhood. The findings of this prospective cohort study suggest that the use of 3-piece IOL models may reduce the risk of pseudophakic VAO in children younger than 2 years of age.

中文翻译：

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生命的头2年儿童人工晶状体植入后的视轴不透明度：来自IoLunder2队列研究的结果。

目的

适当的无晶状体矫正是取得良好疗效的关键。在某些地方或人群中，接触或管理无晶状体接触镜会面临挑战。针对婴儿期初次人工晶状体（IOL）植入后视轴不透明（VAO）风险增加的策略是必要的。我们描述了单侧或双侧先天性或婴儿性白内障在2岁以下儿童中原发性IOL植入后VAO的预测因素。

设计

通过国家临床网络进行的基于人群（联合王国和爱尔兰）的前瞻性队列研究。

参加者

在2009年1月至2010年12月的头2年中，共有105例儿童（双侧白内障57例，单侧白内障48例，总计162眼）接受了人工晶状体植入术。

方法

纵向观察性研究，采用多层次，多变量模型，可研究感兴趣的结果与儿童和治疗特定因素之间的关联，这些因素包括年龄，眼轴长度，社会经济状况，IOL模型和术后使用类固醇激素。

主要观察指标

术后增生性或炎症性视轴不透明（VAO）需要手术矫正。

结果

视轴不透明发生在67眼（45％），通常在术后第一年内。使用三件式IOL模型（赔率[OR]，0.3； 95％置信区间[CI]，0.09-0.99，P = 0.03）并增加手术年龄（OR，0.97，95 ％CI，0.95-0.99） ，P = 0.02）各自独立地预防增殖性VAO的发生。炎症性VAO与社会经济剥夺独立相关（OR为5.39； 95％CI为1.46-19.89；P = 0.01）。

结论

眼轴混浊在儿童期人工晶体植入后很常见。这项前瞻性队列研究的结果表明，使用3件式IOL模型可以降低2岁以下儿童假晶状体VAO的风险。