Choice of IOL in Pediatric Cataract Surgery

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Choice of IOL in Pediatric Cataract Surgery

• M. Edward Wilson, MD
• Rupal H. Trivedi, MD
• Storm Eye Institute
• Medical University of South Carolina

The authors have no financial interest
2
Introduction

• Primary IOL implantation is an accepted method to
  treat aphakia in selected children undergoing
  cataract surgery.
• An IRB approved 11-question web-based survey was
  sent to AAPOS members.
• The responses were received anonymously on a
  secured server.

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Questionnaire

• Location of your current practice
  USA/Canada/other
• Are you currently implanting an IOL in children
  lt18 years? Yes/No
  If you answer yes to this question, please
  proceed following questions.
• Approximately, how many pediatric IOL
  implantations do you perform each year?
• What is your lens of choice for IOL bag-fixation
  in children? PMMA/Foldable
• If foldable, which specific IOL do you routinely
  use for IOL bag-fixation in children? AcrySof
  Natural SN series/AcrySof single-piece SA
  series/AcrySof three piece MA series/Sensar/Silico
  ne/others (please specify)
• What is your lens of choice for IOL
  sulcus-fixation in children? PMMA/Foldable
• If foldable, which specific IOL do you routinely
  use for IOL sulcus-fixation in children? AcrySof
  Natural SN series/AcrySof single-piece SA
  series/AcrySof three piece MA series/Sensar/Silico
  ne/others (please specify)
• Would you consider implanting a
  multifocal/accommodative IOL in children?
  Yes/No/Not sure
• If yes, which IOL? AcrySof ReStor/Crystalens/ReZo
  om/others (please specify)/not sure
• If yes, above what age?
• Any comments?

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Results

• 44/876 emails were returned as undeliverable.
• 329/832 (39.5) responses were received.
• 227/329 (69.0) of the respondents were
  implanting IOLs in children.
• Approximate number of IOL implantation/year -
  median - 10 (8 versus 20 per year for USA and
  non-USA respondents, respectively).
  - total - 4044 (2133 per year US, and 1911
  non-US respondents respectively).

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Lens of choice for bag-fixation
6
Lens of choice for bag-fixation
7
Preferred type of AcrySof for bag-fixation
8
Lens of choice sulcus-fixation
9
Lens of choice for sulcus-fixation
10
Preferred type of AcrySof for sulcus-fixation
11
Multifocal/accommodative IOL
Would you consider?
If yes, which?
1 did not reply.

• Many respondents commented on their concern about
  the use of multifocal/accommodative IOLs in kids.
  
• Many respondents noted reluctance to use
  multifocal IOLs is kids until long-term follow-up
  on these IOLs is available.
• Some raised concerns related to refractive shift,
  and the potential for degradation of amblyopia
  due to loss of contrast sensitivity.

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Summary

• Single-piece AcrySof IOLs were preferred by
  AAPOS members for bag-fixation in children.
• Three-piece AcrySof IOLs were preferred by many
  AAPOS members for sulcus fixation.
• The result of our survey also indicates interest
  for multifocal/accommodative IOLs for older
  children.