We appreciate the interest of Takkar and colleagues in our recent publication, “Myopic shift 5 years after IOL implantation in the Infant Aphakia Treatment Study.”1 We previously published the changes in axial length in the treated and fellow eyes for both the contact lens and intraocular lens (IOL) treated groups.2 The difference in axial length growth between treated and fellow eyes was not significant and the change in axial length between treated eyes in the contract lens and IOL groups was similar at age 5 years (CL 3.2 mm, IOL 3.4 mm). While animal studies have reported that the relative peripheral refraction affects the rate of axial growth, studies in human have failed to find this association.3–5 To the contrary, two recent studies found that the myopic shift increased when myopic children switched from spectacles to contact lenses.6,7 We have not been able to identify preoperative factors that are helpful in predicting the magnitude of the myopic shift in infantile eyes following unilateral cataract surgery and IOL implantation. This is another reason to defer implanting an IOL in an infant’s eye in addition to the higher adverse event rate associated with IOL implantation compared to aphakia.8 By deferring IOL implantation until the axial length of these eyes has stabilized, the risk of high anisometropia and an IOL exchange can potentially be adverted.
by
Duncan E Berry;
Clay J Bavinger;
Alcides Filho Fernandes;
John Mattia;
Jalika Mustapha;
Lloyd Harrison-Williams;
Moges Teshome;
Matthew J Vandy;
Jessica Shantha;
Steven Yeh
The largest Ebola virus disease (EVD) outbreak occurred from 2013–2016 in West Africa, leading to over 28,600 cases and 11,300 deaths and resulted in the largest cohort of EVD survivors to date.1 Another recent outbreak in Democratic Republic of the Congo (DRC) has resulted in 3,481 cases with over 1,170 survivors since August 2018.2 In studies of large EVD survivor cohorts, uveitis is the most common ocular manifestation with a 13–34% reported prevalence.3,4 Cataract, with or without uveitis, is the second most common finding and has been reported in 10% of EVD survivors.3,4 The Ebola Virus Persistence in Ocular Tissues (EVICT) study was a cross-sectional study which supported the safety of cataract surgery in EVD survivors5, but may not be generalizable to vitreoretinal surgery. Posterior segment findings in EVD survivors have been described primarily in relationship to uveitis and include vitritis, chorioretinitis and chorioretinal scarring.3,6 The prevalence of posterior segment findings in EVD survivors, particularly those that may require surgical intervention, is of particular interest given the risk of Ebola virus (EBOV) persistence in ocular tissues and fluids.7