Intraocular lenses for pediatric implantation: Biomaterials, designs, and sizing

Posterior chamber intraocular lenses (IOLs) are being implanted in children with increasing frequency. However, with rare exceptions, only IOLs designed for adults are currently available. These lenses may be difficult to insert into small eyes. Since the pediatric crystalline lens is smaller than that of adults and because the capsular bag does not continue to grow after lensectomy, it is worthwhile to determine the biomaterials, designs, and sizes that may be appropriate for pediatric implantation. In a study of 50 pediatric eyes obtained postmortem, we have documented an estimated growth curve for the developing crystalline lens between birth and 16 years of age. Ninety percent of crystalline lens growth occurs during the first two years of life. Based on these data and this study using the Miyake posterior view analysis of implanted standard and prototype IOLs, we recommend the following: Clinical trials of capsular IOLs, downsized to approximately 10.0 mm diameter, are appropriate for children under two years of age. Capsular IOLs are defined as flexible open-loop, one-piece, all poly(methyl methacrylate), modified C-loop designs made specifically for in-the-bag placement. Because the rapid growth phase of the lens is complete by the age of two, we believe that downsizing the IOL is not necessary after this age unless axial length measurements indicate an unusually small eye. Standard flexible 12.0 mm to 12.5 mm diameter capsular IOLs can be safely implanted. Such lenses could be tolerated throughout life, obviating the need for later IOL exchange.