Postoperative Complications in Bilateral Aphakia Versus Bilateral Pseudophakia 5 Years After Cataract Surgery: Randomized Clinical Trial
Narrative Responses:
Purpose
A comparative evaluation of adverse events of bilateral congenital cataract surgery in children younger than 2 years of age with and without intraocular lens (IOL) implantation with a minimum of 5 years follow-up
Methods
Randomized clinical trial of 60 children undergoing bilateral congenital cataract surgery randomized to:primary aphakia(n=30)or primary IOL implantation(n=30).Surgical technique identical in all eyes except IOL implantation.In aphakics,+25.0Dcontact lenses prescribed on day 1.Trial with aphakic spectacles was mandated.Followup was 1 week,1 month,every 3months during first year,6monthly thereafter upto 5years.At each follow-up,glaucoma, corneal clarity,peripheral anterior and posterior synechiae,IOL centration,visual axis obscuration(VAO),and cell deposits were noted under anesthesia.Change in visual acuity was assessed from preoperatively to 5 year postoperative followup.
Results
Median age of the patients at time of surgery was 5.41 months(Aphakia), and 5.69 months(Pseudophakia)(P=0.56,Mann-WhitneyTest).5 years postoperatively,more number of aphakic eyes developed glaucoma(16.7%) compared to pseudophakia(11.7%);however,difference was not statistically significantly different (P=0.43).Incidence of posterior synechiae was significantly more in pseudophakia group(29% eyes) compared to aphakia group(3% eyes)(P<0.0001).In pseudophakia group,40% eyes developed cell deposits.VAO was 7% in aphakia group compared to 10% in pseudophakia group(P=0.51).Change in visual acuity from preoperatively to final followup was significantly better in pseudophakic group as compared to aphakia group
Conclusion
More number of aphakic eyes developed glaucoma,although difference was not statistically significant.VAO was not significantly different between groups.IOL implantation achieved better visual outcome.Results of this randomized clinical trial 5 years following surgery showed a similar incidence of serious complications and better visual outcomes in pseudophakic eyes compared to aphakic eyes