Prospective analysis of pediatric pseudophakia: myopic shift and postoperative outcomes

Limited data exist about long-term refractive changes in eyes of children with intraocular lens (IOL) implantation. Information of postoperative results should allow more accurate predictions for IOL power implantation in children. Data regarding IOL complications, including secondary membranes, myopic shift, stereopsis, and pseudophakic glaucoma should also be reported.

In a prospective study, the refractive errors of all pediatric patients between 12 months and 18 years who had cataract surgery and IOL implantation were evaluated at 4 weeks, 3 months, 6 months, 1 year, and every 6 months thereafter. All patients were followed for a minimum of 3 years.

Fifty-two eyes of 42 patients met inclusion criteria. Forty-two eyes had developmental cataracts. There were 10 bilateral cases. Of the 52 eyes, 85% had 20/40 vision or better. Visual acuity of 20/30 or better was achieved in 95% of bilateral eyes. In unilateral cataracts, visual acuity was 20/50 or better in 74% of eyes. Mean follow-up time was 5.45 years with a range of 3 to 10.5 years. Mean follow-up by age group ranged between 4.38 and 6.35 years. Children operated on at 12 months to 2 years of age had a mean myopic shift of -5.96 D; children operated on at 3 and 4 years of age had a -3.66 D shift; children operated on at 5 and 6 years of age had a shift of -3.40 D; children operated on at 7 and 8 years of age had a shift of -2.03 D; children operated on at 9 and 10 years of age had a mean shift of -1.88 D; children operated on at 11 to 14 years of age had a shift of -0.97 D; children operated on at 15 to 18 years of age had -0.38 D shift. No cases of pediatric pseudophakic glaucoma were observed. Secondary membrane occurred in 72% of eyes when the capsule was left intact. The operated eye showed a greater mean myopic shift than the nonoperated eye. No statistically significant difference in refractive change was found comparing amblyopic to nonamblyopic eyes or traumatic to nontraumatic cataracts.

The greatest rate of refractive growth or change occurred between 1 and 3 years of age. After age 3 years, the rate of refractive growth followed a more linear trend. Based on this study, we have provided a guide for selecting IOL power in pediatric cataract cases using current formulas with the understanding that new formulas will need to be devised to better predict IOL power in children.