Primary Intraocular Lens Insertion in Infants Under 6 Months of Age: A Retrospective Cohort Study

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Background/Aims: Pediatric cataracts are considered a leading cause of visual impairment. While intraocular lens (IOL) implantation is mostly performed for children >2 years, its use in younger children remains contentious. This study assessed primary IOL in a unique pediatric population characterized by limited adherence to postoperative care, where primary IOL implantation was favored to minimize the risk of prolonged uncorrected aphakia. Methods: This retrospective study examined primary IOL implantation outcomes in children across three age brackets: below 6 months, 6-12 months, and 1-18 years, focusing on best-corrected visual acuity (BCVA) and complications including glaucoma, toxic anterior segment syndrome (TASS), retinal detachment (RD), and yttrium-aluminum-garnet (YAG)/membranectomy. Results: 169 eyes from 119 patients were evaluated over a median follow-up period of 6.4 years. No significant differences were observed between age groups in terms of LogMAR visual acuity (p = 0.344) or the incidence of postoperative complications such as glaucoma (p = 0.244), retinal detachment (p = 0.244), or TASS (p = 0.960). The incidence of YAG capsulotomy/membranectomy was highest in the <6 months group (36%), compared to 22% in the 6-12 months group and 13% in the >1 year group (p = 0.020). Among unilateral cases, all 3 patients diagnosed before 6 months required YAG/membranectomy. Conclusion: Primary IOL implantation for pediatric cataracts resulted in comparable visual acuity and overall complication rates across all age groups. Although a higher incidence of YAG/membranectomy was observed in children under 6 months, particularly among unilateral cases, most patients still avoided the need for additional surgical intervention. These findings support primary IOL implantation as a valid option for selected patients.

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