Phacoemulsification and primary implantation with bag‐in‐the‐lens intraocular lens in children with unilateral and bilateral cataract

Purpose To report outcome in a paediatric cohort with cataract extraction and implantation of bag‐in‐the‐lens intraocular lens ( BIL‐IOL ). Methods Children younger than 16 years of age subjected to phacoemulsification with primary implantation of BIL ‐ IOL during 2009 through 2013 were analysed retrospectively. Exclusion criteria were uveitis or ≤6 months of follow‐up. Results In total, 109 eyes of 84 children were included; 40 unilateral and 44 bilateral cataracts. For all eyes, median age at surgery was 2.5 years (range 2 weeks to 14.1 years) and 16 children (24 eyes) were ≤6 weeks. Coexisting systemic disease was more common in children with bilateral cataract (24 patients, 54.5%) compared to unilateral cataract (6 patients, 15.0%, p < 0.0001). Ocular comorbidity was more common in unilateral cataracts; n  = 14 eyes (35.0%) compared to bilateral cataracts; n  = 10 eyes (14.5%; p = 0.017). Median follow‐up was 2.8 years (range 7 months to 5.8 years). During the follow‐up period, 15 (13.8%) eyes developed glaucoma and five (4.6%) eyes required treatment for visual axis opacification ( VAO ). Corrected distance visual acuity ( CDVA ) for bilateral cataracts at last follow‐up was 0.42 ± 0.45 (log MAR ; mean± SD ) with 35 (55.6%) eyes attaining a CDVA of ≥0.5 (dec). For unilateral cataracts mean CDVA was significantly poorer; 0.67 ± 0.51 (p = 0.010) with 15 (37.5%) eyes attaining a CDVA of ≥0.5. Conclusion For children having cataract surgery with primary implantation of BIL ‐ IOL , VAO is rare and visual outcome overall good. Unilateral cataracts are associated with a higher proportion of ocular comorbidity and poorer visual outcome.