Cataract Surgery Without Intraocular Lens Implantation



Cataract Surgery Without Intraocular Lens Implantation


Ricardo E. Rodríguez-Rosa, MD



Cataract extraction without IOL implantation may be considered for a subset of pediatric patients based on age, ocular parameters, and associated clinical diagnoses. A discussion about the surgical plan and the options for management of aphakia is advised during the preoperative evaluation.


PREOPERATIVE CONSIDERATIONS (SEE CHAPTER 2)



  • Age:



    • In the Infant Aphakia Treatment Study (IATS), infants younger than 7 months of age who underwent unilateral cataract surgery with IOL implantation were more likely to have adverse events requiring secondary surgeries than those left aphakic.


    • Consider leaving infants <7 months aphakic after cataract extraction.


    • Consider IOL placement in infants younger than 7 months of age if they are likely to experience a prolonged period of uncorrected aphakia postoperatively. (see Chapters 4 and 6)


  • Ocular parameters—Consider leaving infant aphakic if:



    • Corneal diameter <10 mm.


    • Axial length <17 mm.


    • History of poorly controlled uveitis: (see Chapter 7)



      • It is recommended that children with uveitis be quiet for at least 3 months prior to cataract surgery to avoid complications secondary to inflammation.


      • If good postoperative control is not anticipated, consider leaving the child aphakic to prevent fibrosis of the IOL.


    • History of trauma: (see Chapters 7 and 26)



      • If the trauma results in significant zonular dehiscence or capsular violation, there may not be adequate support for an IOL. Consider leaving these children aphakic with the option to possibly place an IOL at a later time.


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May 10, 2021 | Posted by in OPHTHALMOLOGY | Comments Off on Cataract Surgery Without Intraocular Lens Implantation

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