What's new AAPOS 2008 - The Private Eye Clinic

included vitrectomy, capsulotomy, complications, and use of intraocular lenses (IOLs).
Postoperative data included final visual acuity, refraction, number of follow-up visits, and
program support for follow-up.
RESULTS: Of 574 eyes of 415 children (mean age 7.1 years +/- 4.7 [SD]), IOLs were
placed in 416 (87%). At least 1 follow-up was attended by 408 patients (98.3%) (mean
total follow-up 3.5 +/- 1.8 months); 40% of eyes achieved a final visual acuity of 6/18 or
better. Children living farther from the hospital had fewer postoperative visits (P = .04),
while children receiving program support had more visits (P = .001). Factors predictive
of better acuity included receiving an IOL during surgery (P = .04) and provision of
postoperative spectacles (P = .001). Predictive of worse acuity were amblyopia (P =
.003), postoperative complications (P = .0001), unilateral surgery (P = .0075), and
female sex (P = .045).
CONCLUSIONS: The results underscore the importance of surgical training in reducing
complications, early intervention before amblyopia (observed in 40% of patients) can
develop, and vigorous treatment if amblyopia is present. The positive impact of program
support on follow-up is encouraging, although direct financial support may pose a
problem for sustainability. More work is needed to understand reasons for worse
outcomes in girls.
ASCRS white paper. Hydrophobic acrylic intraocular lenses in children.
Wilson ME Jr, Trivedi RH, Buckley EG, Granet DB, Lambert SR, Plager DA,
Sinskey RM, Vasavada AR.
J Cataract Refract Surg. 2007 Nov;33(11):1966-73.
Summary:
1. Hydrophobic acrylic IOLs have improved the intra-operative performance of pediatric
cataract surgery. These hydrophobic acrylic IOLs not only allow easier and safer
implantation in small (even microphthalmic) pediatric eyes, they also help the surgeon
consistently achieve the desired in-the-bag fixation in these eyes.
2. We recommend hydrophobic acrylic IOL implantation in children. Implantation is
usually combined with a posterior capsulectomy and an anterior vitrectomy from infancy
until the age of 5 years. In children older than an infant, combined posterior
capsulectomy, vitrectomy, and hydrophobic acrylic IOL implantation avoids the need for
a secondary intervention in most eyes.
3. In the eyes of infants, VAO (visual axis opacification) is much more common when an
IOL of any type is implanted than in cases of primary aphakia, even when a posterior
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