[IOL choice predictability, 1-year visual outcome, and complications after cataract surgery in children]

Area of Science:

• Ophthalmology
• Pediatric Surgery
• Refractive Error Management

Background:

• Cataract surgery in children presents unique challenges due to the developing visual system.
• Intraocular lens (IOL) power selection requires careful consideration to optimize visual outcomes.
• Under-correction of IOL power is a strategy explored to manage refractive error progression in pediatric patients.

Purpose of the Study:

• To assess the refractive outcomes one year after pediatric cataract surgery.
• To evaluate the impact of intraocular lens (IOL) under-correction on refraction in children.
• To determine the visual prognosis and identify potential therapeutic challenges following pediatric cataract surgery.

Main Methods:

• A retrospective study included 28 children (38 eyes) undergoing unilateral or bilateral cataract surgery with primary IOL implantation.
• Patient ages ranged from 1 month to 17 years at the time of surgery.
• Data collected included age at surgery, cataract type, pre- and post-operative visual acuity, IOL power, and refractive outcomes.

Main Results:

• Under-correction percentages varied by age group: 31% (0-2 years), 12.2% (2-6 years), and 2.3% (>6 years), with a mean of 15.2%.
• One year post-surgery, visual acuity averaged 0.2 LogMAR (6.3/10) for ages 2-6 and 0.1 LogMAR (8/10) for ages >6.
• The 0-2 year age group had the highest revision surgery rate (40%) and the most frequent complication of cellular proliferation (80%).

Conclusions:

• Intraocular lens (IOL) under-correction is necessary in pediatric cataract surgery, with the degree of under-correction needing to decrease as the child's age increases.
• The overall gain in visual acuity from this approach is modest.
• Cellular proliferation remains a significant complication, particularly in the youngest patients (0-2 years).