Workshop 22

Mar 04, 2017 by AAPOS editor in  Workshop

Lessons Learned About Cataract Surgery from the Infant Aphakia Treatment Study

Scott R. Lambert; Elias I. Traboulsi; David A. Plager; David Morrison; Sharon Freedman; Erick Bothun; Carolyn Drews-Botsch

Stanford University
Stanford, CA


Purpose/Relevance:  To share knowledge gained from the Infant Aphakia Treatment Study on the management of unilateral congenital cataracts.

Target Audience:  Pediatric cataract surgeons.

Current Practice:  The management of unilateral congenital cataracts is largely antidotal or based on small retrospective studies.  Important unresolved issues include whether further testing should be performed, how to reduce the incidence of adverse events, what is best type of contact lens to wear in aphakic eyes, how can the risk of glaucoma be reduced, what is the optimal patching regimen to preserve binocularity, how can strabismus be avoided and how do they effect behavioral and motor development.

Best Practice:  We have found that less than 5% of these children have systemic disease and the fellow eye rarely develops a cataract.  Postoperative adverse events can be reduced by not implanting an intraocular lens.  Rigid gas permeable contact lenses are less expensive, available in a wider range of powers and base curves and are easier to insert and remove than silicone contact lenses.  The risk of glaucoma can be reduced by waiting until a child is 6 weeks of age to perform cataract surgery.  Reduced patching after the first year of life is associated with improved binocularity without compromising visual acuity in the treated eye.  Strabismus is less likely to develop if cataract surgery is performed between 4-6 weeks of age.  Finally, children who have undergone unilateral cataract surgery should be evaluated for delayed motor development.

Expected Outcomes:  Attendees will be provided the latest data from a randomized clinical trial to help them practice evidence based medicine.

Format:  The presentations will consist of short didactic lectures, panel discussion and open questions from the audience.  Attendees will be polled before and after the workshop.

Summary:  The workshop will present the latest findings from the Infant Aphakia Treatment Study regarding the management of children with unilateral congenital cataracts.

References:  1. Lambert SR, Lynn MJ, Hartmann EE, DuBois L, Drews-Botsch C, Freedman SF, Plager DA, Buckley EG, and Wilson ME and the Infant Aphakia Treatment Study Group.  Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy.  A randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years.  JAMA Ophthalmol  2014;132:676-682.
2. Plager DA, Lynn MJ, Buckley EG, Wilson ME, Lambert SR. Complications in the first 5 years following cataract surgery in infants with and without IOL in the IATS. Am J Ophthalmol  2014;158:892-898
3. Freedman SF, Lynn MJ, Beck AD, Bothun ED, Orge FH, Lambert SR.  Glaucoma-related adverse events in the first five years after unilateral cataract removal in the Infant Aphakia Treatment Study.  JAMA Ophthalmol 2015;33:907-914.

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