This literature review compared the safety and visual outcomes associated with optical correction using an IOL, contact lenses or spectacles after cataract surgery in children 2 years of age or younger.

Study design: The authors mined PubMed, the Cochrane Library and clinical trial databases to identify all published articles on IOL implantation in early childhood. In all, 34 studies were identified and 14 were selected for assessment. The panel methodologist then assigned a level of evidence rating to these studies.

Outcomes: Intraocular lenses, contact lenses and spectacles were associated with similar visual outcomes, glaucoma risk and strabismus risk for children with bilateral and unilateral cataracts. However, IOLs were associated with an increased risk of visual axis opacities and low corneal endothelial cell counts.

In the subgroup of infants ages 6 months of age or younger, IOL implantation was associated with a higher incidence of visual axis opacities compared with aphakia. Although ocular growth was similar for all treatments, infants younger than 6 months who underwent IOL implantation had large myopic shifts that often resulted in high myopia or severe anisometropia later in childhood.

For children older than 6 months of age, refractive outcomes were unreliable. However, the findings suggest IOL implantation may be pursued in the hands of trained and experienced surgeons. Limitations The authors analyzed multiple studies, which inherently introduces bias. Only one study (ie, the Infant Aphakia Treatment Study) provided Level 1 evidence on IOL implantation in early childhood.

Clinical significance: Infants less than 6 months of age should be left aphakic when possible. For children older than 6 months, the decision should be based on the surgeon’s level of experience and the patient’s individual characteristics.

—Aparna Ramasubramanian MD Cataract/Anterior Segment, Pediatric Ophth/Strabismus