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[Evaluation of predictability and refractive changes in pediatric pseudophakia]
O Arámbulo de Borin1, M Paz, K González
1Servicio Autónomo, Hospital Universitario, Maracaibo, Estado Zulia, Venezuela. odalisab@hotmail.com
Insights
Pediatric cataract surgery outcomes show that younger children (0-2 years) have higher refractive prediction errors and significant refractive changes post-intraocular lens (IOL) implantation. Older children (>2 years) demonstrate better refractive predictability.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Refractive Surgery
Context:
- Pediatric pseudophakia, resulting from cataract surgery with intraocular lens (IOL) implantation, presents unique challenges in refractive predictability due to ongoing ocular development.
- Accurate refractive outcomes are crucial for visual development in children, making precise IOL calculations essential.
Purpose:
- To evaluate the predictability of postoperative refraction and long-term refractive changes in pediatric pseudophakia.
- To compare refractive outcomes across different age groups undergoing cataract surgery with IOL implantation.
Summary:
- A 5-year prospective study followed 60 eyes of 44 pediatric patients (under 15 years) who had cataract surgery with IOLs, divided into four age groups (0-2, 3-5, 6-8, 9+ years).
- The 0-2 year age group exhibited significantly higher refractive prediction errors (1.5±1.8 D) and greater refractive changes over 5 years (-4.7±3.4 D) compared to older groups.
- While the youngest group had high variability, their refractive outcomes were within 2 standard deviations, aligning with rapid axial length growth in early childhood.
Impact:
- Findings indicate that IOL calculation and implantation in children aged 2 years and older yield better immediate and long-term refractive predictability.
- The study highlights the increased variability and refractive shifts in infants and very young children, necessitating careful consideration in IOL selection and management.
- This research informs surgical planning and enhances the understanding of refractive development following pediatric cataract surgery.
Objective:
Evaluate the predictability of the postoperative refraction and refractive changes in pediatric pseudophakia.
Methods:
Prospective, longitudinal follow-up on patients under the age of 15 years operated on for a cataract with intraocular lens, with 5 continuous years of follow-up. The patients were divided into 4 groups according to age at the time of the surgery: group from 0 to 2 years old, from 3 to 5 years old, from 6 to 8 years old, and 9 years and over. Error prediction and refractive change were studied. Statistical analysis was performed using the Student t and ANOVA test.
Results:
A total of 60 eyes were included (44 patients). No significant differences were found between the unilateral and bilateral group. The prediction error in the 0 to 2 years group was 1.5±1.8 D, significantly higher than in the other groups (ANOVA P=.01). Refractive change in 5 years of the group of 0 to 2 years was -4.7±3.4 D (ANOVA P=.0002), while in the other groups it was significantly lower, with no differences between them.
Conclusions:
The 0 to 2 years group was less hyperopic than expected, 100% within the accepted of 2 standard deviations, but with a high variability. The refractive change observed in this group coincides with previous reports that the largest growth and increase in axial length occurs during the first 2 years. The calculation and use of an IOL in children has a better immediate refractive prediction, and at long term in those older than 2 years of age.
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