PURPOSE

To compare outcomes of in-the-bag vs ciliary sulcus secondary intraocular lens (IOL) implantation for pediatric aphakia.

DESIGN

Prospective interventional case series.

METHODS

This institutional study was conducted in 202 children (355 aphakic eyes) diagnosed as having congenital cataracts and who underwent cataract extraction before age 24 months. Pediatric aphakic eyes underwent in-the-bag or ciliary sulcus secondary IOL implantation according to the amount of residual lens capsule and were monitored for 3 years postoperatively. The main outcome measures were adverse events (AEs), IOL tilt and decentration, and best corrected visual acuity (BCVA) in the operative eye.

RESULTS

A total of 144 eyes (40.6%, 89 children) received in-the-bag IOL implantation (capsular group), and 211 eyes (59.4%, 132 children) underwent ciliary sulcus IOL implantation (sulcus group). Kaplan-Meier curves showed that the time-dependent incidence of glaucoma-related AEs (GRAEs) (P = .005) and any AEs (P = .002) were higher in the sulcus group. In-the-bag IOL implantation was a strong protective factor against GRAE (hazard ratio, 0.08; 95% CI, 0.01-0.53; P = .009) and any AEs (hazard ratio, 0.21; 95% CI, 0.08-0.57; P = .002). Clinically significant IOL decentration (>0.4 mm) was more common in the sulcus group compared with the capsular group (vertical decentration: 29.8% vs 15.7%, P = .005; horizontal decentration: 30.3% vs 9.35%, P < .001). BCVA in the capsular group was better than that in the sulcus group (logMAR, 0.56 vs 0.67, P = .014).

CONCLUSIONS

Compared with ciliary sulcus secondary IOL implantation, in-the-bag IOL implantation reduced AEs and yielded better IOL centration and BCVA for pediatric aphakia.

中文翻译：

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袋内与睫状沟二次人工晶状体植入治疗小儿无晶状体：一项前瞻性比较研究

目的

比较袋内植入与睫状沟二次人工晶状体 (IOL) 植入治疗儿科无晶状体的结果。

设计

前瞻性干预病例系列。

方法

这项机构研究在 202 名被诊断患有先天性白内障并在 24 个月前接受了白内障摘除术的儿童（355 只无晶状体眼）中进行。小儿无晶状体眼根据晶状体囊残留量进行囊内或睫状沟二次人工晶状体植入，术后监测3年。主要结局指标是手术眼的不良事件 (AE)、IOL 倾斜和偏心以及最佳矫正视力 (BCVA)。

结果

144眼（40.6%，89名儿童）接受袋内IOL植入（囊组），211眼（59.4%，132名儿童）接受睫状沟IOL植入（沟组）。Kaplan-Meier 曲线显示，眼沟组青光眼相关 AE (GRAE) ( P  = .005) 和任何 AE ( P = .002)的时间依赖性发生率 较高。袋内 IOL 植入是针对 GRAE（风险比，0.08；95% CI，0.01-0.53；P  = .009）和任何 AE（风险比，0.21；95% CI，0.08-0.57；P  = .002）。与囊组相比，沟组更常见临床上显着的 IOL 偏心（>0.4 mm）（垂直偏心：29.8% vs 15.7%，P = .005; 水平偏心：30.3% vs 9.35%，P < .001）。包膜组的 BCVA 优于脑沟组（logMAR，0.56 vs 0.67，P  = .014）。

结论

与睫状沟二次人工晶状体植入相比，袋内人工晶状体植入减少了不良事件，并为小儿无晶状体产生了更好的人工晶状体对位和 BCVA。