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Validation of Guidelines for Undercorrection of Intraocular Lens Power in Children
Virender Sachdeva1, Sushma Katukuri2, Ramesh Kekunnaya3
1Nimmagada Prasad Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India.
Insights
Pediatric cataract surgery often involves undercorrection of intraocular lens (IOL) power. This study found that while many children achieve acceptable refractive error by age 7, younger children (<2 years) may experience more hypermetropia.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Refractive Surgery
Background:
- Undercorrection of intraocular lens (IOL) power is a common strategy in pediatric cataract surgery.
- Long-term refractive outcomes after pediatric cataract surgery with initial IOL undercorrection are not well-established.
Purpose of the Study:
- To analyze the long-term refractive status of children who underwent cataract surgery with initial IOL undercorrection.
Main Methods:
- Retrospective observational study analyzing records of children (<7 years) with IOL implantation and follow-up to ≥7 years.
- Data included demographics, cataract etiology, undercorrection method, and serial refractions.
- Prediction error (refractive error minus emmetropia) at 7 years of age was the primary outcome.
Main Results:
- Eighty-four eyes from 56 children were analyzed; median age at surgery was 3.3 years.
- At 7 years of age, median absolute prediction error was 1.5 diopters.
- Age at surgery was the only significant factor influencing prediction error (β = -0.32; P = .001), with younger children (<2 years) showing a myopic shift.
Conclusions:
- Initial IOL undercorrection may lead to acceptable refractive error by age 7 in pediatric cataract patients.
- Younger children (<2 years) may experience more hypermetropia, suggesting a need for tailored undercorrection strategies.
- Further research is required to validate different undercorrection methods and compare them with existing guidelines.
Purpose:
Initial undercorrection of intraocular lens (IOL power) is a common practice in children undergoing pediatric cataract surgery. However, the long-term refractive status of these children is largely unknown. The purpose of this study is to analyze the long-term refractive status of these children.
Design:
Retrospective observational study.
Methods:
We analyzed records of children (<7 years of age) who underwent cataract surgery with a primary IOL implantation and had completed follow-up to ≥7 years of age. Data were collected regarding demographics, etiology of cataract, method of undercorrection, and serial follow-up refractions. Prediction error was defined as refractive error minus emmetropia. The main outcome measure was prediction error at 7 years of age.
Results:
Eighty-four eyes of 56 children (28 unilateral and 28 bilateral cases) met the study criteria. The median age at surgery was 3.3 years (interquartile range 2.7-5 years), and the median follow-up period was 3.75 years. At 7 years of age, the median absolute prediction was 1.5 diopters (interquartile range 0.75-2 diopters). Seven of 84 (8.3%) children achieved emmetropia while an equal proportion were myopic (45%) or hypermetropic (46%). Prediction error (adjusted for using both eyes) at 7 years of age was not significantly different in any group (P > .05). Maximum myopic shift was observed in children <2 years of age. Age at surgery was the only significant factor that influenced prediction error (â = -0.32; P = .001).
Conclusion:
This study suggests that children undercorrected using guidelines suggested by Enyedi and associates may achieve an acceptable refractive error at 7 years of age. However, in children <2 years of age, more hypermetropia may be observed. More studies are needed to validate various methods of undercorrection and compare with other guidelines.
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