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    Determining best cases for IOL implantation in children

    When the topic of IOL implantation is on the table, the age of the patient does make a difference, according to pediatric expert Courtney Kraus, MD, who spoke at the Wilmer Eye Institute’s 27th annual Current Concepts in Ophthalmology conference.

    “IOL implantation is an option for some, but not all, pediatric patients. When circumstances warrant an IOL, the surgeon must anticipate the expected myopic shift and plan accordingly,” she said during her presentation, “IOL Selection in a Pediatric Surgery Case.”

    Dr. Kraus spoke of some current trends in IOL use in the pediatric population and addressed reasons why aphakia correction differs between children and adults.

    • First, a child’s eye experiences multiple periods of growth during early infancy and childhood. “Additionally, refractive elements of the eye undergo radical changes,” Dr. Kraus said.

    • Secondly, there is a risk of amblyopia development, especially if the visual input is “defocused or unequal” between the two eyes.

    • Third, aphakic or pseudophakic glaucoma risks are higher in the pediatric population.

    • Lastly, social and environmental factors affect short- and long-term outcomes, which may influence the choice of treatment.

    Currently, optical aphakia correction in children entails aphakic glasses, aphakic contact lenses, and primary or secondary IOL implantation. There are advantages and disadvantages to each.  

    “Numerous factors play a role in the decision of what means is employed to correct for aphakia: unilateral versus bilateral cataracts; age of the patient; and family/social factors,” Dr. Kraus said.

    She added, “The advantages of leaving the baby aphakic and visually rehabilitating the eye with a contact lens include the ability to change the contact lens power as needed to keep up with the rapidly growing eye’s refractive needs, not subjecting the baby to the potential for complications and the need for additional surgeries seen frequently with IOL implantation, and not requiring spectacle wear for the first few years of life.”

    However, in older children the decision to place an IOL is “usually pretty clear,” she noted.

    Pursuit of IOL implants

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