Contact lens intolerance in infantile aphakia - indication for intraocular lenses?

Due to the low rate of complications, lentectomy and contact lens fitting is the standard treatment for congenital cataract. However, contact lens fitting is not possible in all children. The authors report the main reasons for discontinuation of contact lenses in their patients. Method: In 134 consecutive lentectomies of 90 children, the underlying eye diseases and general diseases,the age at operation, compliance of parents and children, and social background were analyzed. Results: Twenty of the 90 children had to discontinue contact lens wearing. Twelve of these children were operated on one eye and 8 on both eyes. Only 2 children showed signs of contact lens complications. In 2 children treatment was stopped because of the poor visual prognosis and in 10 children the parents discontinued contact lens treatment because of a severe handicap of the child (n = 2) or due to misunderstanding and pa rental noncompliance (n = 8). Six children refused contact lenses without obvious reasons. Among the latter, children 2-4 years of age were at the greatest risk. Children with additional systemic abnormalities frequently developed contact lens intolerance. Conclusion: In children with systemic abnormalities and in the case of parental communication and compliance problems, discontinuation of contact lenses has to be expected in up to 30 % of cases. In these children and in children who object to contact lenses at the age of 2-4 years, intraocular lens implantation should be considered, especially in unilateral cataract, if successful contact lens treatment is not achievable within 8-12 weeks.