Overcoming myopic shift by the initial inductive hypermetropia in pediatric cataract surgery

To assess the outcome of under-correction of intraocular lens (IOL) power in pediatric cataract surgery.

We collected clinical data of 103 patients (181 eyes), all aged ≤15 years, who had undergone cataract surgery by a surgeon during 2006-2016. The mean duration of follow-up was 73 ± 38 months (range: 24-108). IOL power was calculated by Hoffer Q formula in axial length (AL) <21 mm and SRKT formula in AL ≥21 mm and then modified based on this approach: 7D initial inductive hypermetropization in children ≤1-year-old, 5D in 1-3, 3.5D in 3-5, 2.5D in 5-7, 1.5D in 7-9, 1D in 9-10, and 0 in children >10 years old.

The mean age of all children at surgery time was 5.85 ± 4.56 years (range: 1-178 months). There was a mean myopic shift of -6.379 D in the ≤1 year, -5.532 in the 1-3, -3.194 in the 3-5, -2.301 in the 5-7, -1.06 in the 7-9, -1.567 in the 9-10, and 0.114 in the >10-year-old age group. In 125 eyes (69.1%) of 181, the final SE was between -2 and +2 D, and 21 eyes (11.6%) achieved the goal of emmetropization. Mean best-corrected visual acuity logarithm of the minimum angle of the resolution was 0.30 in children ≤1 year, 0.39 in 1-3, 0.21 in 3-5, 0.18 in 5-7, 0.14 in 7-9, 0.16 in 9-10, and 0.11 in children >10 years old.

This study shows a larger myopic shift in younger children. Using our approach, all age groups could finally achieve acceptable final refraction.