Introduction
Approximate 1.4 million children suffer from blindness around the world.1 Childhood preventable blindness has been identified
as a priority of the Vision 2020: “The Right to
Sight”2. Pediatric cataract is the leading cause of
treatable childhood blindness and accounts for 5 - 20% of childhood
blindness3-5.
IOL implantation is the main option for optical rehabilitation in
children after cataract surgery. There are two main surgical procedures
for IOL implantation in cataract infants, i.e. primary IOL implantation
and primary aphakia followed by secondary IOL implantation. Due to the
risk of postoperative complications, such as inflammatory responses, VAO
and secondary glaucoma, IOL implantation in cataract children older than
2 years has been a consensus among pediatric cataract surgeons around
the world6-9.
But in other cases, children with
aphakic spectacles or contact lenses are susceptible to VA issues,
corneal problems, compliance with lens-wearing and high cost.
Many studies had reported the clinical performance (including VA and
postoperative complications) after congenital cataract
surgery7,10-12. However, given the elongation of axial
length, change of corneal curvature and high incidence of additional
surgery, the benefits and risks of primary IOL implantation in cataract
infants, especially in those younger than 2 years, still remains a
controversial issue13-15. Surgeons need
to
weigh the visual benefits agains risk (such as inflammatory response,
VAO and secondary glaucoma associated with the procedure) of surgery
when they choose IOL implantation for a children younger than 2 years.
Glaucoma is the main complication of congenital cataract surgery and has
been discussed in many studies16-18.
However,
there is no consistent conclusion on which type of surgery can decrease
the incidence of glaucoma. Some studies suggested that primary IOL
implantation was a protective factor of glaucoma after cataract
surgery19,20. Whereas, other studies suggested that
the incidences of glaucoma were comparable in primary IOL group and
primary aphakia group 11,21,22.
Similarly,
previous studies didn’t reach consensus on which type of procedure would
be better in terms of postoperative VA and
complications23,24. Therefore, the present
meta-analysis aims to compare the postoperative performance of primary
IOL implantation and primary aphakia in cataract infants younger than 2
years, and provide solid evidence for better clinical practice.