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    Clinical Round Up: No glaucoma protection from primary IOL placement in children

    No glaucoma protection from primary IOL placement in children

    By Cheryl Guttman Krader

    Durham, NC—Glaucoma-related adverse events are common after cataract removal in infancy—despite modern surgical techniques—according to results from follow-up to age 5 in the prospective, randomized Infant Aphakia Treatment Study (IATS).

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    In addition, they are consistent with previous studies in showing that young age and small corneal diameter at time of surgery are risk factors for these events, said Sharon F. Freedman, MD.

    Primary IOL placement was not found to protect children having cataract surgery in infancy from developing glaucoma or becoming glaucoma suspects to age 5 years.

    However, previous studies indicate that 5 years is the median age of onset of glaucoma after cataract surgery during infancy, and so the investigators are looking to longer follow-up when children reach 10 years of age for a more definitive answer about the potential impact of primary IOL placement.

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    “The issue of whether a primary IOL protects against development of glaucoma after cataract removal in infancy is controversial,” said Dr. Freedman, IATS investigator, chief of pediatric ophthalmology, Duke Eye Center, and professor of ophthalmology and pediatrics, Duke University School of Medicine, Durham, NC. “Two retrospective studies that did not use predefined definitions of glaucoma or glaucoma suspect and one recent meta-analysis suggested that it does. However, there are other retrospective studies and one prospective study that found a primary IOL was not protective after controlling for follow-up time and selection factors.

    “A prospective randomized study was needed, and the IATS addresses that need,” she continued.

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    The IATS is a multicenter trial funded by the National Eye Institute that randomly assigned 114 infants ages 1 to 6 months undergoing unilateral cataract surgery to have in-the-bag primary IOL implantation with spectacle over-correction or to be left aphakic and wear a contact lens (CL). The primary outcome measure was visual acuity at age 5, but glaucoma was investigated as a secondary outcome.

    The surgical procedure was standardized for all children and included cataract removal and posterior capsulotomy with anterior vitrectomy. Children with a small cornea (<9 mm), IOP >25 mm Hg at surgery, or persistent fetal vasculature causing visible stretching of ciliary processes were excluded from enrollment.

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