medwireNews: In young children with bilateral cataracts, significantly fewer glaucoma-related adverse events occurred by 7 years of age when intraocular lens (IOL) implantation after lensectomy was done at a younger rather than an older age, prospective data have shown.
In a study of 158 children with bilateral aphakia who were seen at the Zhongshan Ophthalmic Center at Sun Yat-sen University in Guangdong, China, glaucoma-related adverse events occurred in 47 (14.9%) of 316 eyes overall.
These events were most likely to occur in children who were aged 5–6 years at the time of secondary IOL implantation, affecting 22.6% of eyes in this group. In comparison, glaucoma-related adverse events occurred in 15.6% of eyes among children aged 4–5 years, 9.0% of eyes among those aged 3–4 years, and 8.8% of eyes among those aged 2–3 years at the time of secondary IOL implantation, with significant differences between the groups.
Yet, rates of best-corrected visual acuity (BCVA) were similar across the age groups, at respective means of 0.65, 0.60, 0.59, and 0.49 logMAR (respective Snellen equivalents 20/89, 20/80, 20/78, and 20/62) in the oldest to youngest children.
“[T]he optimal timing of IOL implantation remains one of the most debated issues, particularly in children with bilateral cataracts,” Weirong Chen (Sun Yat-sen University) and colleagues write in JAMA Ophthalmology.
“These findings suggest that the timing of secondary intraocular lens implantation is not associated with visual prognosis, but implantation age may be associated with glaucoma-related adverse events,” the researchers say.
Their study was performed between 2014 and 2023 and involved children (65.2% male) who had cataracts of both eyes with a central dense opacification of more than 3 mm and underwent lensectomy before 2 years of age.
The children subsequently underwent a separate IOL implantation procedure under general anesthesia, which was performed by “highly experienced cataract surgeons,” the team points out. Overall, the median age at primary lens extraction was 5.6 months and the median age at secondary IOL implantation was 4.3 years.
The researchers report that the majority of eyes (41 of the 47) in which the glaucoma-related events occurred were classified as glaucoma, according to The Childhood Glaucoma Research Network criteria, with six eyes classified as suspect glaucoma. They also report that 16.8% of the total eyes studied required additional surgical interventions, but there were no differences among the age groups.
Limitations of the study included no fixed protocol for when IOL implantation should occur, the relatively small number of children in each age group, and the assessment outcomes being fixed at 7 years of age. The investigators note, however, that they plan to continue follow-up assessments beyond this timepoint.
William Good (Smith-Kettlewell Eye Research Institute, San Francisco, California, USA) writes in an invited commentary that the results of the study were both “unexpected” and “promising” and that they “could help reduce the rate of aphakic glaucoma in children with infantile cataracts.”
However, Good also says that “many of these children had their primary surgery (lensectomy) at an age that would normally result in some degree of occlusion amblyopia, yet visual acuity outcomes were only moderately reduced.”
He adds that “visual acuity outcomes can be expected to be better than those reported here when lensectomy is performed at an earlier age.”
There are several important messages according to Good. “First, there is no reason not to place secondary implants in children as young as 2 years of age,” he says. Second, “a strong argument can be made that earlier surgery is better than waiting until an infant is older,” and third, and “[f]inally, an experienced surgeon will obtain better results.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2025 Springer Healthcare Ltd, part of Springer Nature
JAMA Ophthalmol 2025; doi:10.1001/jamaophthalmol.2025.1080
JAMA Ophthalmol 2025; doi:10.1001/jamaophthalmol.2025.1243
