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Choice of lens and dioptric power in pediatric pseudophakia
1St. John Eye Hospital, Johannesburg, South Africa.
Insights
Younger children undergoing intraocular lens (IOL) implantation experience a greater myopic shift. Undercorrection with lifelong spectacle adjustment is recommended to manage refractive development in pediatric pseudophakic eyes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Refractive Surgery
Background:
- Pediatric intraocular lens (IOL) implantation requires careful consideration of refractive development.
- Understanding the impact of IOL choice and power on visual outcomes in children is crucial.
Purpose of the Study:
- To evaluate the relationship between IOL selection and dioptric power in pediatric eyes.
- To assess refractive development following posterior chamber IOL implantation in children.
Main Methods:
- Retrospective analysis of 156 pseudophakic eyes in 99 children (1 month to 8 years old).
- Children grouped by age at IOL implantation (1-18 months, 19-36 months, 3-8 years).
- Use of poly(methyl methacrylate) posterior chamber IOLs, with dioptric power intentionally undercorrected.
Main Results:
- Younger children (1-18 months) showed significant axial length growth (3.59 mm) and myopic shift (6.39 D).
- Older children (19-36 months and 3-8 years) exhibited less axial growth and myopic shift.
- A clear correlation between younger age at implantation and greater myopic progression was observed.
Conclusions:
- Age at IOL implantation is a key factor influencing myopic shift in pediatric eyes.
- Undercorrection of IOL power, with subsequent spectacle adjustment, is advised.
- This approach aims to achieve emmetropia or moderate myopia in adulthood, minimizing IOL exchanges.
Purpose:
To evaluate lens choice and dioptric power in pediatric eyes having posterior chamber intraocular lens (IOL) implantation.
Setting:
Oxford Eye Center and the St. John Eye Hospital, Johannesburg, South Africa.
Methods:
This retrospective study evaluated the refractive development in 156 pseudophakic eyes of 99 children aged 1 month to 8 years who had surgery between June 1983 and April 1994. The children were divided into three groups based on age at time of IOL implantation: Group A (68 eyes), 1 to 18 months; Group B (32 eyes), 19 to 36 months; Group C (48 eyes), 3 to 8 years. Poly(methyl methacrylate) posterior chamber IOLs with an overall diameter between 10.5 and 12.0 mm were used. The dioptric power was 3.00 to 6.00 diopters (D) less than that needed to achieve emmetropia.
Results:
In Group A, the mean growth in axial length was 3.59 mm +/- 1.80 (SD) and the mean change in refraction was 6.39 +/- 3.68 D. In Group B, the respective means were 0.75 +/- 0.85 mm and 2.73 +/- 1.40 D and in Group C, 0.76 +/- 0.69 mm and 2.60 +/- 1.84 D.
Conclusions:
The younger the child at time of implantation, the greater the myopic shift. To reduce the necessity of IOL exchange, these eyes should be undercorrected, with the residual refractive error corrected by spectacles that are adjusted throughout life according to refractive development. This leads to initial hypermetropia that gradually moves to emmetropia or moderate myopia in adulthood.