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Rotating the Intraocular Lens to Prevent Posterior Capsular Opacification in Cataract Surgeries
Published on: July 7, 2023
Refractive outcomes after cataract surgery with primary lens implantation in infants
J-S Barry1, P Ewings, C Gibbon
1West of England Eye Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK. johnsbarry@doctors.org.uk
Insights
Infant cataract surgery outcomes show variable refractive results, but bilateral cases exhibit consistent refractive changes, potentially indicating emmetropization. Postoperative refraction over +4.5 diopters helps prevent early myopia.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Refractive Error Management
Background:
- Cataract surgery in infants presents unique challenges for refractive outcome prediction.
- Accurate intraocular lens (IOL) power selection is crucial for optimizing visual development in young children.
Observation:
- This study analyzed refractive outcomes, IOL power accuracy, and visual results in 14 eyes of 8 infants (<1 year old) undergoing cataract surgery.
- Median follow-up was 37.25 months, with initial postoperative refraction averaging +6.75 diopters.
Findings:
- Refractive outcomes were unpredictable and varied between infants, though bilateral surgeries showed consistent refractive patterns.
- A decreasing myopic shift was observed in 8 eyes, suggesting potential emmetropization. Postoperative refraction exceeding +4.5 diopters was associated with avoidance of early-onset myopia.
- The difference between predicted and actual refraction ranged from -2.85 to +2.97 diopters using the SRK-T formula.
Implications:
- While refractive outcomes are variable, consistent patterns in bilateral cases offer insights into emmetropization post-infantile cataract surgery.
- Encouraging visual results suggest improved management strategies compared to historical data.
- Further research is needed to identify causes of erratic refractive changes in some infant eyes.
Aims:
To show the refractive outcomes, accuracy of intraocular lens power selection, and visual outcomes and complications in infants undergoing cataract surgery.
Methods:
The refraction (spherical equivalent) of 14 operated eyes in 8 children aged <1 year was plotted over time. Preoperative and final recorded visual acuities were assessed.
Results:
The median follow-up was 37.25 months. The median initial postoperative refraction was (+)6.75 dioptres.
Conclusions:
Refractive outcomes for each eye were not entirely predictable and were variable between infants. However, there was a consistent pattern in each infant who underwent bilateral surgery, with both eyes following a similar pattern of refractive change with time: a decreasing myopic shift was seen in 8 eyes, possibly demonstrating emmetropisation. The two unilateral cases appeared to show a linear myopic shift. 4 eyes in 2 patients did not follow a myopic shift curve and one of these patients showed an early trend towards increased hyperopia. Definite causes for this erratic refractive change were not identified. A postoperative refraction >4.5 dioptres avoided early onset myopia. The range of difference between postoperative and predicted refraction using SRK-T was (-)2.85 to 2.97 dioptres. Most of the visual results are encouraging compared with historical data in older children.
