Tailored strategies to reduce opioid overdose deaths for pregnant and postpartum women: Examples and lessons learned from the HEALing Communities Study.

The landmark Infant Aphakia Treatment Study (IATS) recommended that visually significant unilateral congenital cataracts in infants <7 months of age be managed by lensectomy, posterior capsulotomy, anterior vitrectomy, and postoperative correction of aphakia without intraocular lens (IOL) implantation. The investigators noted that IOL insertion was associated with higher rates of secondary surgery (63.1% vs 12.3% after 1 year), predominantly due to visual axis opacification (VAO) by lens epithelial cell (LEC) proliferation. This recommendation continues to be debated in the context of other studies showing more favorable VAO outcomes with IOL implantation. The varying practice patterns and lack of consensus call for a better understanding of risks associated with IOL insertion versus aphakia in infants. The most common indication for secondary surgery in the IATS aphakic group was also VAO, including capsular phimosis. Significant capsular phimosis hinders retinoscopic refraction and may cause deprivational amblyopia that can be as devastating as the original cataract. As repeat surgery incurs additional familial stress, high monetary costs, and concerns for long-term neurologic effects caused by repeated general anesthesia exposure, surgeons must understand what intraoperative steps reduce the risk of capsular phimosis. Tan and colleagues developed software that quantified VAO (defined as LEC proliferation with or without capsular opening area contraction) based on manual delineation of the capsulotomy perimeter. They found that smaller anterior capsulotomy size, measured intraoperatively, increased risk of VAO. By evaluating capsular phimosis, they differ from most relevant studies that focus on other forms of VAO; however, their classification scheme was mostly driven by LEC proliferation. Moreover, their cross-sectional study’s aim did not include reporting the time of onset or number of visually significant cases requiring intervention. No study to date has exclusively examined capsular phimosis in infants. The purpose of the current study was to evaluate risk factors for capsular phimosis following unilateral and bilateral infantile cataract removal without IOL insertion.