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Changes in Ocular Growth after Pediatric Cataract Surgery
1Department of Ophthalmology, School of Medicine, Emory University, Atlanta, Ga., USA.
Insights
Child cataract surgery may slightly slow eye growth, but less than in animals. Undercorrecting vision in children with intraocular lenses (IOLs) is recommended to account for future myopia.
Area of Science:
- Ophthalmology
- Pediatric ophthalmology
- Developmental biology
Background:
- Human eye development involves axial elongation, corneal flattening, and reduced lens power.
- Infant lens removal in animal models retards axial elongation.
- Congenital cataracts in children are associated with shorter axial length, persisting post-surgery.
Purpose of the Study:
- To investigate the effect of cataract extraction on axial elongation in children.
- To evaluate the challenges of intraocular lens (IOL) power selection in pediatric eyes.
- To determine appropriate refractive targets for pediatric IOL implantation.
Main Methods:
- Review of studies on axial elongation in children post-cataract extraction.
- Analysis of differences in axial length between cataractous and fellow eyes.
- Consideration of ocular growth and IOL power calculation complexities in pediatric patients.
Main Results:
- Axial elongation reduction after cataract extraction in children is modest, significantly less than observed in animal models.
- Axial length differences between operated and fellow eyes generally persist post-surgery.
- Pediatric ocular growth and biometric measurement challenges complicate IOL power selection.
Conclusions:
- Cataract extraction has a limited impact on retarding axial elongation in children compared to animal studies.
- The natural growth of the pediatric eye necessitates undercorrection with intraocular lenses (IOLs) to anticipate myopic shift.
- Accurate IOL power calculation and refractive targets are crucial for managing pediatric visual development post-surgery.
Abstract:
The human eye undergoes extensive changes during early childhood, including axial elongation, corneal flattening and reduced lens power. Animal studies have shown that removing the crystalline lens during infancy retards axial elongation. Axial elongation has been studied in children after cataract extraction both directly and indirectly. Children with a unilateral congenital cataract generally have a shorter axial length in their cataractous eye than in their fellow eye. This difference usually persists after cataract surgery. While some studies have reported a modest reduction in axial elongation after cataract extraction, the magnitude of this effect is much less than what has been reported in animal models. Choosing an intraocular lens (IOL) power for implantation into a child's eye is complicated by continued ocular growth, the inaccuracy of IOL power calculation formulas for small eyes, and the difficulty of accurately measuring the biometrics of a child's eye. In addition, given the fixed position of an IOL in the eye, increasing elongation of the posterior segment of the eye relative to the anterior segment magnifies the myopic shift that occurs with ocular growth. The targeted refractive error in young children undergoing IOL implantation should be an undercorrection in anticipation of a future myopic shift.
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