Visual Acuity and Complications at Age 7 Years Following Bilateral Secondary Intraocular Lens Implantation at 2 to Younger Than 6 Years for Pediatric Aphakia

Importance The optimal timing for secondary intraocular lens (IOL) implantation in children with bilateral aphakia remains uncertain, with important implications for long-term visual outcomes and the risk of complications such as glaucoma. Determining when to implant to achieve the best visual outcomes while minimizing complications is critical for improving clinical decision-making in pediatric cataract management. Objective To report the visual acuity (VA) and complications in children with bilateral aphakia after lensectomy for pediatric cataracts, undergoing secondary IOL implantation at different ages. Design, Setting, and Participants This single-center prospective observational cohort study, conducted from 2014 to 2023, is a 7-year follow-up study. A total of 251 children met the inclusion criteria. After exclusion, 158 children were enrolled in this study. These 158 children (316 eyes) underwent lensectomy before the age of 2 years, followed by secondary IOL implantation between the ages of 2 and younger than 6 years in bilateral pediatric cataracts. Exposure Study participants were categorized into 4 groups based on the timing of secondary IOL implantation (2 to <3 years, 3 to <4 years, 4 to <5 years, and 5 to <6 years). Main Outcome and Measure Best-corrected VA (BCVA) outcomes at age 7 years after secondary IOL implantation in children with bilateral pediatric cataracts. Results Among the 158 children included in the study, 103 (65.2%) were male. At age 7 years, the mean (SD) BCVA for children who underwent secondary IOL implantation was 0.49 (0.35) logMAR (Snellen equivalent, 20/62) at 2 to younger than 3 years, 0.59 (0.36) logMAR (Snellen equivalent, 20/78) at 3 to younger than 4 years, 0.60 (0.30) logMAR (Snellen equivalent, 20/80) at 4 to younger than 5 years, and 0.65 (0.34) logMAR (Snellen equivalent, 20/89) at 5 to younger than 6 years ( P = .20). Glaucoma-related adverse events occurred in 47 eyes in total: 6 eyes (8.8%), 7 eyes (9.0%), 10 eyes (15.6%), and 24 eyes (22.6%) across the groups, respectively, with a statistical difference among the groups ( P = .03). Conclusions and Relevance These findings suggest that secondary IOL implantation performed between the ages of 2 and younger than 6 years following bilateral pediatric cataract lensectomy can achieve comparable visual outcomes; however, the risk of glaucoma increases with older implantation age.