Study finds, Delayed IOL implantation ensures better refract
This secondary analysis of IATS—a multicenter, randomized clinical trial involving 114 infants who remained aphakic or were randomized to primary IOL placement—evaluated visual and refractive outcomes and adverse events at age 10.5 years in patients who received a secondary IOL.

--Nearly all (55 of 57) patients randomized to aphakia with contact lens correction were evaluated at 10.5 years; 24 (44%) of these patients had secondary IOL surgery at a median age of 5.4 years.

--Mean absolute prediction error was 1.0 ± 0.7 D. The logMAR visual acuity of these eyes was 0.9, which was comparable to vision in the 31 eyes still aphakic at 10.5 years.

--A similar number of eyes in both groups remained stable or had improved visual acuity between the 4.5- and 10.5-year visits.

--For the 22 eyes that received an IOL after the 4.5-year visit, mean refraction at age 10.5 years was -3.2 D compared with -5.5 D in eyes with primary IOL.

Prediction error after cataract surgery in children is more variable than it is with adults. Since significant axial elongation occurs in early childhood, pseudophakic eyes can experience large degrees of myopic shift.

This study shows that the shifts are sometimes greater than anticipated even with delayed surgery. While delayed implantation leads to a more predictable refractive outcome range at 10.5 years, the range of refractive error is still large.

In addition, the results show that it is important to counsel families that visual acuity after IOL implantation is not expected to be significantly different than the visual acuity obtained with contact lens or spectacle use. Interestingly, less than 50% of patients received an IOL by age 10.5 years in this study. There are refractive advantages to delaying secondary IOL surgery until school age. When an experienced surgeon performs the elective surgery after age 5 years, the complication rate is low and there are far fewer adverse effects than when the surgery is performed during infancy.