Multifocals in children
Multifocal IOLs achieve good results in treatment of paediatric cataracts
Multifocal intraocular lenses are a good option for children with cataracts, provided that the patients are selected appropriately, said Laurence Lesueur MD, Toulouse, France.
“In 2019, multifocality in children with the latest generation of premium hydrophobic acrylic IOLs should be proposed and discussed, especially for unilateral and bilateral cataracts after the age of five years,” Dr Lesueur told the WSPOS Subspecialty Day in Paris, France.
She cited the French SAFIR study, in which 41 eyes of 33 children underwent multifocal IOL implantation and had a minimum follow-up of one year and a mean follow-up of 25 months. The mean distance best-corrected visual acuity (BCVA) improved from a preoperative value of 0.66 logMAR to 0.24 logMAR and the mean postoperative distance uncorrected visual acuity (UCVA) was 0.42 logMAR. In addition, the mean near postoperative UCVA was 0.44 logMAR and the mean near BCVA was 0.28 logMAR. Moreover, 43.5% of patients were spectacle-independent postoperatively.
The children in the retrospective multi-centre study were aged nine months to 15 years, with a mean age of seven years. This included 30 unilateral and 11 bilateral cataract cases with congenital, traumatic or iatrogenic cataracts. Children under five years of age also underwent posterior capsulorhexis and anterior vitrectomy. The study’s exclusion criteria were corneal disease, glaucoma, microphthalmos, pupil deformation, retinopathy, neuro-ophthalmic disease and ocular inflammation.
The lenses used in the study included the ReSTOR SN 60 AD3-AD1 (Alcon), the Tecnis ZMA00, the AMO NXG1, and the Acri.LISA Toric (ZEISS). There were no significant differences between the different types of multifocal IOL in terms of visual outcome or the incidence of posterior capsular opacification requiring YAG laser capsulotomy, which occurred in 43.5% of cases overall.
She noted that several other notable studies have investigated the use of multifocal IOLs for paediatric cataracts. They suggest that the myopic shift is greater in the eye without the implant in unilateral cases and that bilateral cases tend to achieve the greatest degree of stereopsis. Studies also show promising results in some of the newer trifocal IOLs.
Dr Lesueur noted that while questions remain about the sometimes-unpredictable myopic shift that can occur in patients even in the second decade of life, where necessary, laser refractive surgery performed in adulthood can achieve good refractive and anatomical results.