ASCRS white paper. Hydrophobic acrylic intraocular lenses in children.

After Sir Harold Ridley’s invention of the intraocular lens (IOL) in 1949, Dr. Edward Epstein implanted an IOL in a 12-year-old aphakic child in 1952. However, implantation in pediatric eyes was slow to catch on as many early attempts at IOL implantation in children resulted in complications. These results have been attributed to a lack of awareness of the need for primary posterior capsulectomy and vitrectomy, poor IOL design for children, and the inherent propensity for an increased inflammatory response in a child’s eye after intraocular surgery. Advances in surgical techniques and technologies resulted in a reduction in the postsurgical inflammatory response, even in the highly reactive eyes of children. Improvements in IOL design are important contributing factors in this regard. Implantation of IOLs in children began to increase steadily in the 1980s and early 1990s. This increase was the result of the introduction of poly(methylmethacrylate) (PMMA) IOLs, which were highly polished, downsized to 12.0 mm overall length, and equipped with more flexible haptics. In addition, the use of mechanized vitrectomy instrumentation to selectively perform a primary posterior capsulectomy and vitrectomy combined with IOL implantation resulted in fewer reoperations in younger children. Soon after its introduction in the mid 1990s, the hydrophobic acrylic IOL assumed a prominent role in adult cataract surgery. Because posterior capsule opacification (PCO) is one of the most frequent and severe complications in pediatric cataract surgery, reports that acrylic IOLs decreased the incidence of PCO after adult cataract surgery prompted pediatric cataract surgeons to use this material in pediatric eyes. The