Secondary Intraocular Lens Placement

  • Kamiar MireskandariEmail author


The Infant Aphakia Treatment Study (IATS) has shown that cataract surgery in infants with primary intraocular lens (IOL) implantation has more complications with no added visual benefit (Lambert et al., JAMA Ophthalmol 132(6):676–682, 2014; Plager et al., Ophthalmology, Elsevier Inc. 118:2330–2334, 2011). Therefore, most surgeons perform lensectomy, posterior capsulotomy, and anterior vitrectomy in infants up to 7 months of age and contact lenses or glasses are used for visual rehabilitation. The peripheral capsular bag is preserved in the anticipation of these children undergoing secondary IOL implantation when older (Kim et al., Acta Ophthalmol 90: 231–236, 2012; Speeg-Schatz et al, J Cataract Refract Surg 31:750–756, 2005). The natural healing response in children is for the capsular bag to fuse and lens epithelial cells to proliferate inside the bag with the formation of a Soemmering ring. The technique for implanting an IOL secondarily in children is discussed in detail in this chapter. A step-by-step guide to visualizing and opening the Soemmering ring, aspiration of proliferating lens matter, and IOL implantation with optic capture is demonstrated.


Aphakia  Secondary IOL  Intraocular lens  Soemmering ring  Pediatric 


Conflicts of Interest

No financial disclosures or conflicts of interest

Supplementary material

Video 17.1

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  1. 1.
    Kim DH, et al. Long-term results of bilateral congenital cataract treated with early cataract surgery, aphakic glasses and secondary IOL implantation. Acta Ophthalmol. 2012;90(3):231–6. Scholar
  2. 2.
    Lambert SR, et al. Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. JAMA Ophthalmol. 2014;132(6):676–82. Scholar
  3. 3.
    Plager DA, et al. Complications, adverse events, and additional intraocular surgery 1 year after cataract surgery in the Infant Aphakia Treatment Study. Ophthalmology, Elsevier Inc. 2011;118(12):2330–4. Scholar
  4. 4.
    Speeg-Schatz C, Flament J, Weissrock M. Congenital cataract extraction with primary aphakia and secondary intraocular lens implantation in the ciliary sulcus. J Cataract Refract Surg. 2005;31(4):750–6. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Ophthalmology and Visual SciencesHospital for Sick Children and University of TorontoTorontoCanada

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