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Published on: July 7, 2023
Stability of Astigmatism Following Lensectomy for Pediatric Cataract
Erick D Bothun1, Desirae R Sutherland2, Sarah R Hatt1
1From the Mayo Clinic (E.D.B., S.R.H., D.A.L.), Rochester, Minnesota, USA.
Insights
Astigmatism increased by less than 0.50D in children 5 years after cataract surgery when axis changes were ignored. However, accounting for axis changes revealed significant astigmatism progression in about 1 in 6 eyes, questioning the use of toric intraocular lenses in pediatric cases.
Area of Science:
- Ophthalmology
- Pediatric ophthalmology
- Refractive surgery
Background:
- Pediatric cataract surgery requires careful consideration of refractive outcomes.
- Astigmatism management is crucial for visual development in children.
- Intraocular lens (IOL) implantation is standard in pediatric lensectomy.
Purpose of the Study:
- To evaluate the change in astigmatism up to 5 years postoperatively in children undergoing lensectomy with primary IOL implantation.
- To assess the impact of axis changes on astigmatism progression using power vector analysis.
Main Methods:
- Post hoc analysis of a prospective cohort study including children under 13 years old.
- Astigmatism change calculated using clinical notation and power vector analysis (J0, J45) to account for axis shifts.
- Comparison of refractive data from early postoperative period (60 days to 1.5 years) to 5-year follow-up (4-6 years postoperatively).
Main Results:
- Mean clinical astigmatism increased by 0.37 D (CI: 0.26-0.48 D) over 5 years.
- Power vector analysis showed a mean astigmatism change of 1.06 D (CI: 0.95-1.18 D).
- Approximately 16% (CI: 11%-22%) of eyes experienced an astigmatism change of 2.00 D or more when axis changes were included.
Conclusions:
- While simple clinical measurement shows minimal astigmatism increase, power vector analysis reveals substantial changes in pediatric eyes after lensectomy and IOL implantation.
- Significant astigmatism progression in a notable proportion of eyes suggests caution regarding the use of toric IOLs in this population.
- Further research is needed to optimize refractive outcomes and IOL selection for pediatric cataract surgery.
Purpose:
To evaluate change in astigmatism after postoperative healing was completed through 5 years following pediatric lensectomy with primary IOL implantation DESIGN: Post hoc analysis of a prospective cohort study PARTICIPANTS: Children <13 years of age who had early postoperative (60 days to 1.5 years postoperatively) and 5-year refraction data (4-6 years postoperatively).
Main Outcome Measure:
Change in astigmatism.
Methods:
Change in astigmatism was calculated in 2 ways: (1) using clinical notation for astigmatism without regard to axis change and (2) using cylinder conversion to power vectors (J0, J45) to include the impact of axis changes. With conversion back to clinical notation, we calculated the change in the astigmatic component of the refraction between the early postoperative exam and 5 years.
Results:
Among 213 children, mean (SD) age was 5.4 (3.2) years; among 266 study eyes, 153 (58%) were from bilateral cases. Mean clinical astigmatism was + 1.24 D (95% confidence interval [CI] 1.11-1.38 D) at early postoperative exams and + 1.61 D (95% CI: 1.47-1.75 D) at 5 years (mean change: +0.37 D, 95% CI: 0.26 to 0.48 D). Using power vector conversions, the mean change in astigmatism was 1.06 D (95% CI: 0.95-1.18 D). The proportions of children with astigmatism > 0.50 D postoperatively (N = 185) who had a change ≥ 1.00 D and ≥ 2.00 D were 47% (95% CI: 40%-55%) and 16% (95% CI: 11%-22%), respectively. Change in astigmatism was not associated with age at lensectomy (0.00 D per 1 year older, 95% CI: -0.04 to 0.04, p = .92) when analyzed with power vector conversions.
Conclusions:
When disregarding axis change, there was less than 0.50D increase in clinically determined astigmatism 5 years after cataract surgery. However, analysis of astigmatism change using power vectors with conversion back to clinical notation (accounting for change in magnitude and axis), about 1 in 6 eyes had a change of 2.00 D or more in the astigmatic component of their refraction. This suggests that toric IOLs may not be appropriate for pediatric cataract surgery.
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