Changing refractive outcomes with increasing astigmatism at longer-term follow-up for infant cataract surgery

PurposeTo present longer-term refractive and ocular health outcomes for patients who had primary intraocular lens (IOL) insertion following infant cataract surgery.Patients and methodsA retrospective review of all infant cataract cases at a tertiary children's hospital between 2003 and 2006 was conducted. Surgery was performed before 12 months of age. IOL power was calculated using the SRK/T formula targeting hyperopia based on the child's age; children under 3 months were targeted at +9.0 D, between 3 and 6 months at +6.0 D, and between 6 and 12 months at +3.0 D. Locally weighted scatterplot smoothing and mixed models were used.ResultsA total of 12 eyes from 9 children were included (4 bilateral and 5 unilateral). Spherical equivalent refraction decreased dramatically in the first 2 years of life, with milder changes from age 2 to 4 years and minimal changes thereafter. Cylinder increased until age 5 years at ∼0.57 dioptres/year (95% confidence intervals 0.27-0.87 D, P<0.001). Lens reproliferation was the commonest complication (58%). All children eventually developed strabismus.ConclusionEarly and frequent refraction is critical in the first 2 years of life to try and compensate for the rapid changes encountered in the growing eye. Astigmatism may be another important consequence to manage.