IOL Use Could Expand to Younger Infants

Congenital cataract is one of the leading causes of childhood blindness, and early intervention and treatment are crucial. Swedish research suggests this urgency should include a reappraisal of how doctors work with intraocular lenses (IOLs).

A recent presentation by Arzu Seyhan Karatepe Haşhaş MD highlighted the Swedish approach towards finding the right time to implant IOLs in treating this condition, which she says goes against current standard practice.

Dr Karatepe Haşhaş noted IOL implantation in patients under the age of 1 is typically rare and extremely rare in patients younger than 3 months. However, surgeons will opt to use IOLs in patients aged up to 2 years when possible, and there are usually no problems with older patients.

The Swedish approach is rather different. First, all congenital cataract patients are entered into the Paediatric Cataract Register (PECARE), a national registry for paediatric cataracts that includes diagnostic, surgical, and postoperative data.

“In Sweden, infants [younger than] 12 months often receive primary IOLs when possible. Two national centres are certified for cataract surgery in children [younger than] 3 years of age: Stockholm and Gothenburg,” Dr Karatepe Haşhaş said.

“At St Eriks Hospital in Stockholm, a one-piece acrylic hydrophobic IOL in a capsular bag is used. In Gothenburg, at Sahlgrenska University Hospital, a one-piece acrylic hydrophilic bag-in-the-lens (BIOL) is used [with] the Tassignon technique.”

Dr Karatepe Haşhaş reported that a study based on PECARE’s data found BIOLs achieved lower rates of visual axis opacification—3.8% and 8.8% unilaterally and bilaterally—compared with 23.1% and 37.3% for aphakia and 71.2% and 53.9% for in-the-bag IOLs.

Could the same positive results be visible in visual acuity outcomes? Could patients younger than the aforementioned 3-month threshold also receive BIOLs? Dr Karatepe Haşhaş believes so, based on a study involving 80 unilateral and 82 bilateral congenital cataract patients, all of whom were operated on under this age threshold.

The results demonstrated that earlier surgery produced better outcomes. In both groups, those operated on before 6 weeks of age were associated with improved visual acuity across all three methods compared to those treated after 6 weeks of age.

Bilateral cases also showed little difference between the three methods. However, in unilateral cases, Dr Karatepe Haşhaş reported that visual acuity in the BIOL group was 0.5 logMAR five years postoperatively, whereas aphakia and the IOL-in-the-bag technique scored 1.3 and 0.9 logMAR, respectively.

This data, she added, demonstrates BIOLs as a viable option for congenital cataract treatment. Not only that, but she also believes this approach could and should become standard practice.

“If you operate on an infant, then you should implant an IOL if you can, especially if you have access to BIOLs,” Dr Karatepe Haşhaş said. “It may offer the best patient outcomes, especially in unilateral cases.”

Dr Karatepe Haşhaş presented at the 2025 ESCRS Annual Congress in Copenhagen.

Arzu Seyhan Karatepe Haşhaş MD is working as a consultant ophthalmologist at Sahlgrenska University Hospital, Sweden, specialising in paediatric cataract and glaucoma surgery as well as vitreoretinal surgery. She is a Fellow of the European Board of Ophthalmology and continues clinical research as a PhD student at the University of Gothenburg, Sweden. arzu.karatepe.hashas@vgregion.se