Incidence of secondary intraocular lens implantation in school-aged children left aphakic to age 4.5 years in the Infant Aphakia Treatment Study

Purpose: To determine the incidence of secondary intraocular lens (IOL) implantation in a cohort of children randomized to aphakia after unilateral congenital cataract surgery. Setting: 12 clinical sites in the United States. Design: Randomized clinical trial. Data regarding secondary IOL implantation were collected retrospectively when patients were age 10.5 years. Methods: We calculated the cumulative incidence of secondary IOL implantation in participants in the Infant Aphakia Treatment Study who were randomized to aphakia to age 4.5 years and were followed at age 10.5 years. Results: 22 (43%, 95% CI, 29%-58%) of the 51 participants left aphakic to age 4.5 years who had better than light perception vision at age 4.5 years received a secondary IOL by age 10.5. More than half (59%) of these were implanted by age 6 (median 64.5 months, interquartile range 60-80). Secondary IOLs were implanted in children with good visual acuity (≤20/40), as well as those with poor visual outcomes (≥20/200) (39% and 44%, respectively). Children who received a secondary IOL did not report less contact lens wear than those remaining aphakic (average of 94% of waking hours vs 90%, respectively). However, the proportion of children receiving a secondary IOL varied substantially by study center. Conclusions: Many children with unilateral congenital cataract who are initially left aphakic remain aphakic throughout the elementary school years. Practice patterns and family preference seem to be important drivers of the decision to implant a secondary IOL in these children.