Paediatric secondary intraocular lens estimation from the aphakic refraction alone: comparison with a standard...

To compare the following two methods of paediatric secondary posterior chamber intraocular lens (PCIOL) determination with the Holladay formula: (1) estimation from the aphakic refraction alone (using assumed keratometry (K) of 44 diopters); and (2) calculation based on preoperative measured biometry.

(1) Retrospective medical record review in a referral eye hospital of children with aphakia aged < or =12 years who underwent secondary PCIOL implantation with an Alcon MA60BM lens; (2) PCIOL determination for a plano refraction by the above two methods (estimation and calculation); and (3) prediction of pseudophakic refraction for the PCIOL actually implanted by the above two methods compared with the actual pseudophakic refraction.

50 eyes of 30 children with aphakia were studied. The estimated (mean, 95% confidence interval (CI)) secondary PCIOL values (25.81, +/-1.65 D) and the calculated secondary PCIOL values (26.35, +/-1.50 D) were not significantly different (mean absolute value of the difference 1.86 D, 95% CI +/-0.41 D) by the two-tailed paired t test at alpha = 0.05 (p = 0.11). For each eye, the pseudophakic refractions predicted by the two methods for the PCIOL that was actually implanted differed, both from each other and from the actual pseudophakic refraction (repeated-measures analysis of variance, p<0.001; Tukey test, p<0.01).

The method of PCIOL estimation from the aphakic refraction alone provides values similar to those obtained by a standard technique and can be useful if biometry is unavailable. Targeting a pseudophakic refraction in paediatric aphakia is prone to error.