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Title

Long-term follow-up of “bag-in-the-lens” pediatric cataract surgery

Purpose	To evaluate the long-term follow-up of the bag-in-the-lens intraocular lens (BIL IOL) in pediatric cataract surgery.
Methods	All pediatric cataract surgeries using the BIL IOL that completed a follow-up period of more than 5 years in our department were included in the study. Type of cataract, age at time of surgery, ocular and systemic pathology were recorded. Follow-up examination included best corrected visual acuity (BCVA), refraction, anterior and posterior segment evaluation, axial length measurement and orthoptic examination.
Results	Between July 1999 and September 2007 133 eyes of 107 children were operated using the BIL IOL. Of this group 46 eyes of 33 children completed a follow-up of at least 5 years. Follow-up ranged from 60 to 157 months (mean: 78). Age at time of surgery ranged from 2 months to 14 years and 11 eyes of 7 children were below the age of 1 year at time of surgery. BCVA improved postoperatively in all cases except one. Of the bilateral cases nearly all recovered up to normal visual acuity. Of the unilateral cases none fully recovered. All patients had acceptable postoperative refraction. Spherical equivalents were distributed around emmetropia, with a tendency towards light myopia. The visual axis remained clear in nearly all cases. In 4 eyes, where proper BIL IOL implantation was not feasable, visual axis reopacification (VAR) occurred and secondary surgery was needed.
Conclusion	The "bag-in-the-lens" implantation in babies and children gives very promising results. When properly implanted, it prevents the occurrence of VAR, allowing early intensive visual rehabilitation. However, despite this major advantage the unilateral cataracts still have the worst prognosis regarding visual recovery.

Authors 1

Last name	VAN LOOVEREN
Initials	J
Department	UZA
City	Antwerpen

Authors 2

Last name	BAKKER
Initials	E
Department	UZA
City	Antwerpen

Authors 3

Last name	GODTS
Initials	D
Department	UZA
City	Antwerpen

Authors 4

Last name	DE VEUSTER
Initials	I
Department	UZA
City	Antwerpen

Authors 5

Last name	TASSIGNON
Initials	MJ
Department	UZA
City	Antwerpen