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Theoretic refractive changes after lens implantation in childhood
1Department of Ophthalmology and Clinical Investigation, Naval Medical Center, San Diego, California 92134-5000, USA.
Ophthalmology
|December 31, 1997
Summary
Children with pseudophakia (artificial lenses) experience significant myopic shift, especially when surgery occurs before age two. Initial hyperopic correction may reduce this shift and extreme myopia in growing children.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Refractive Surgery
Background:
- Children with aphakia (absence of the lens) typically show decreasing hyperopia with age.
- Long-term refractive changes in pediatric pseudophakia are not well-documented, despite reports of significant myopic shifts.
Purpose of the Study:
- To theoretically calculate the long-term refractive effects of pseudophakia in children.
- To analyze refractive changes in pediatric eyes after cataract surgery and intraocular lens (IOL) implantation.
Main Methods:
- Retrospective chart review of eyes undergoing cataract surgery before age 10 with over 7 years of refraction data.
- Calculation of theoretical IOL powers for emmetropia at surgery and comparison of final pseudophakic refractions to a logarithmic myopic shift model.
Main Results:
- A median pseudophakic refraction of -6.6 D was observed after a mean follow-up of 11 years.
- Children operated on before age 2 exhibited significantly greater and more variable myopic shifts compared to older children.
- The predictive model was accurate within 3 D for 24% of eyes operated on before age 2 and 77% of those operated on after age 2.
Conclusions:
- Pediatric pseudophakia is associated with substantial myopic shift, particularly in infants and very young children.
- Implanting IOLs to achieve initial hyperopia may mitigate the extent of myopic shift and resultant extreme myopia.
- Surgeons must anticipate considerable variability in long-term refractive outcomes in young children receiving IOLs.