Phakic intraocular lens correction of high ametropia in children with neurobehavioral disorders

J AAPOS. 2008 Jun;12(3):282-9. doi: 10.1016/j.jaapos.2007.12.001.


Purpose: A subset of children with high ametropia and neurobehavioral disorders have chronic difficulties with spectacle or contact lens wear. We report the results of refractive surgery in a series of these children treated using bilateral or unilateral phakic intraocular lenses (IOLs) for ametropia >10 D.

Methods: Clinical course and outcome data were collated prospectively in a group of 12 children (mean age, 10.1 years; range, 4-17 years) with neurobehavioral disorders exacerbated by poor compliance with spectacles. Myopia in 18 eyes ranged from -10.0 to -22.75 D (mean, -15.2 D) and in 2 hyperopic eyes from +10.25 to +10.75 (mean, +10.5 D). Goal refraction was approximately 0 to +1 D. Correction was achieved by implantation of an iris-enclaved phakic IOL under general anesthesia. Mean follow-up was 9.1 months (range, 3-15 months).

Results: Myopia correction averaged 14.5 D and hyperopia correction 9.4 D. Eighty-six percent of eyes (17/20 eyes) were corrected to within +/- 1 D of emmetropia and the remaining 14% (3 eyes) to within +/- 2 D. Uncorrected visual acuity improved substantially in all 20 eyes (60-fold; from a mean of 20/3400 to a mean of 20/57). Ocular comorbidities in each child accounted for residual postoperative, subnormal visual acuity (eg, amblyopia, nystagmus, albinism, regressed retinopathy of prematurity). Visual functions (measured using a 23-item validated survey) improved. One eye required IOL exchange; no other clinically significant complications have been encountered.

Conclusions: Phakic IOL implantation improves visual function substantially in neurobehaviorally impaired children who have high ametropia and difficulties wearing glasses.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child Behavior Disorders / complications*
  • Child, Preschool
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperopia / complications
  • Hyperopia / physiopathology
  • Hyperopia / surgery*
  • Iris / surgery*
  • Lens Implantation, Intraocular
  • Male
  • Myopia / complications
  • Myopia / physiopathology
  • Myopia / surgery*
  • Phakic Intraocular Lenses*
  • Prospective Studies
  • Prosthesis Design
  • Refraction, Ocular
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome