Comparative analysis of visual outcomes of multifocal and monofocal intraocular lenses in congenital cataract surgery

Purpose: To assess the impact on visual development of multifocal vs monofocal intraocular lenses (IOLs) implantation in children after congenital cataract surgery. Setting: Ophthalmology Department, Bambino Gesù Children’s Hospital, Rome, Italy. Design: Retrospective interventional consecutive case series. Methods: Records of 56 eyes of 43 pediatric patients who underwent congenital cataract surgery with phacoaspiration and simultaneous implantation of the IOL younger than 1 year were reviewed. Corrected distance visual acuity (CDVA), refractive error, and ocular motility disorders were evaluated at follow-up of greater than 4 years. Results: 32 multifocal (18 unilateral, Group A and 14 bilateral, Group B) and 24 monofocal (12 unilateral, Group C and 12 bilateral, Group D) IOLs were implanted. Mean follow-up was 6.67 years. Mean CDVA of the eyes with multifocal IOLs was 0.75 ± 0.46 logMAR in unilateral cataract surgery and 0.34 ± 0.25 logMAR in bilateral ones; with monofocal IOLs was 0.71 ± 0.52 logMAR in unilateral and 0.53 ± 0.43 logMAR in bilateral ones. No statistically significant difference in the CDVA between Groups A and B and Groups C and D were recorded. Final mean spherical equivalent was −3.88 ± 4.73 diopters (D); in Group A, it was −2.74 ± 4.22 D, in Group C was −1.08 ± 1.45 D, in Group B was −4.82 ± 4.64 D, and in Group D was −6.81 ± 4.61 D. The difference was statistically significant between Groups B and D ( P = .01), but not between Groups A and C ( P = .14). 26 patients (60.4%) showed postoperative strabismus. Surgical correction occurred more in patients with multifocal IOLs implanted ( P = .038). Conclusions: Multifocal IOLs did not show significant advantages in visual development in children after congenital cataract extraction younger than 1 year when compared with monofocal IOLs.