The Upgradeable Pediatric Intraocular Lens: Early Clinical Outcomes Of A Modular System

To report current clinical data on the use of a dedicated modular intraocular lens (IOL) system in a pediatric cohort.

S. Fyodorov Eye Microsurgery Federal State Institution, Cheboksary, Russia

This prospective interventional case series included 88 consecutive eyes of children aged 2 months to 18 years, implanted with a modular IOL since March 2022. Indications were congenital/developmental (67 eyes), acquired (13), and traumatic (8) cataracts. In congenital cataracts, implantation settings included primary (55), secondary (9), haptic-only (2), and exchange of a standard IOL for modular (1). Mean age at implantation was 4.3±4.9 years, with 39 eyes implanted in patients <1 year old (average 0.5±0.2 years). Mean follow-up was 0.75±0.89 years. Most IOLs for primary implantation were assembled ex vivo; intraocular assembly occurred in 3 eyes.

Complication data are reported for congenital cataracts. Intraoperative: iris trauma (1). Postoperative: visual axis opacification – VAO (8), glaucoma (1), uveitis (2). One bilateral case had severe uveal reaction: first eye required two interventions (including iridoplasty) preserving visual potential; second eye developed glaucoma and corneal opacity after multiple procedures including optic explantation. Other unplanned interventions: VAO removal (8), strabismus surgery (4). Mean age was lower in eyes with VAO (0.73 vs. 2.43 years; p=0.03). Critically, in one patient (2 eyes) optic exchange was performed >3 years post-primary implantation to correct high myopia, demonstrating feasibility of refractive adjustment.

Current data suggest the modular IOL's safety profile is clinically comparable to traditional implants in children. Crucially, the feasibility of the modular platform's second stage—optic exchange to adjust refractive power—was successfully demonstrated, supporting its potential for long-term pediatric refractive management. The implant demonstrated predictable performance during follow-up of up to 4 years.