In-the-Bag Versus Ciliary Sulcus Secondary Intraocular Lens Implantation for Pediatric Aphakia: A Prospective Comparative Study

Zhenzhen Liu, Haotian Lin, Guangming Jin, Xuhua Tan, Bo Qu, Ling Jin, Xiaoyun Chen, Wei Wang, Xiaotong Han, Jingmin Xu, Guishuang Ying, Ying Han, Mingguang He, Nathan Congdon, Weirong Chen, Lixia Luo, Yizhi Liu

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PURPOSE To compare outcomes of in-the-bag vs ciliary sulcus secondary intraocular lens (IOL) implantation for pediatric aphakia. DESIGN Prospective interventional case series. 
METHODS This institutional study was conducted in 202 children (355 aphakic eyes) diagnosed as having congenital cataracts and who underwent cataract extraction before age 24 months. Pediatric aphakic eyes underwent in-the-bag or ciliary sulcus secondary IOL implantation according to the amount of residual lens capsule and were monitored for 3 years postoperatively. The main outcome measures were adverse events (AEs), IOL tilt and decentration, and best corrected visual acuity (BCVA) in the operative eye. 
RESULTS A total of 144 eyes (40.6%, 89 children) received in-the-bag IOL implantation (capsular group), and 211 eyes (59.4%, 132 children) underwent ciliary sulcus IOL implantation (sulcus group). Kaplan-Meier curves showed that the time-dependent incidence of glaucoma-related AEs (GRAEs) (P = .005) and any AEs (P = .002) were higher in the sulcus group. In-the-bag IOL implantation was a strong protective factor against GRAE (hazard ratio, 0.08; 95% CI, 0.01-0.53; P = .009) and any AEs (hazard ratio, 0.21; 95% CI, 0.08-0.57; P = .002). Clinically significant IOL decentration (>0.4 mm) was more common in the sulcus group compared with the capsular group (vertical decentration: 29.8% vs 15.7%, P = .005; horizontal decentration: 30.3% vs 9.35%, P < .001). BCVA in the capsular group was better than that in the sulcus group (logMAR, 0.56 vs 0.67, P = .014). 
CONCLUSIONS Compared with ciliary sulcus secondary IOL implantation, in-the-bag IOL implantation reduced AEs and yielded better IOL centration and BCVA for pediatric aphakia.
Original languageEnglish
Pages (from-to)183-192
JournalAmerican Journal of Ophthalmology
Early online date12 Oct 2021
Publication statusPublished - Apr 2022


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