Refractive change in pediatric pseudophakia: 6-year follow-up

[Evaluation of predictability and refractive changes in pediatric pseudophakia]

OBJECTIVE

Evaluate the predictability of the postoperative refraction and refractive changes in pediatric pseudophakia.

METHODS

Prospective, longitudinal follow-up on patients under the age of 15 years operated on for a cataract with intraocular lens, with 5 continuous years of follow-up. The patients were divided into 4 groups according to age at the time of the surgery: group from 0 to 2 years old, from 3 to 5 years old, from 6 to 8 years old, and 9 years and over. Error prediction and refractive change were studied. Statistical analysis was performed using the Student t and ANOVA test.

RESULTS

A total of 60 eyes were included (44 patients). No significant differences were found between the unilateral and bilateral group. The prediction error in the 0 to 2 years group was 1.5±1.8 D, significantly higher than in the other groups (ANOVA P=.01). Refractive change in 5 years of the group of 0 to 2 years was -4.7±3.4 D (ANOVA P=.0002), while in the other groups it was significantly lower, with no differences between them.

CONCLUSIONS

The 0 to 2 years group was less hyperopic than expected, 100% within the accepted of 2 standard deviations, but with a high variability. The refractive change observed in this group coincides with previous reports that the largest growth and increase in axial length occurs during the first 2 years. The calculation and use of an IOL in children has a better immediate refractive prediction, and at long term in those older than 2 years of age.

Factors influencing stereoacuity levels after surgery to correct unilateral developmental cataracts in children

AIM

To evaluate factors influencing stereoacuity after surgery to correct unilateral developmental pediatric cataracts.

METHODS

We retrospectively surveyed 110 patients who had undergone removal of unilateral acquired developmental cataracts and primary posterior chamber intraocular lens implantation between February 1992 and December 2009. In all patients, stereoacuity was assessed using the Titmus test at the last follow-up period of minimum 2 years after surgery. Patients were divided into two groups according to the extent of stereoacuity: group 1 (n=42) had stereoacuity values≤100sec/arc and group 2 (n=68) values >100sec/arc. The values of ten parameters associated with stereoacuity were measured in each group: Cataract types, preoperative best corrected visual acuity (BCVA) of the affected eyes, preoperative inter-ocular difference of BCVA, age at cataract surgery, operative method, secondary cataract, postoperative strabismus, postoperative BCVA of the affected eyes, postoperative inter-ocular difference of BCVA, and anisometropia.

RESULTS

The extent of stereoacuity was significantly associated with both operative method and secondary cataract (P=0.000 and P=0.016, respectively). All patients in whom the posterior capsule was preserved, had poor stereoacuity >100sec/arc. Significant correlations with the extent of stereoacuity were found with postoperative strabismus (P=0.048), postoperative BCVA of the affected eyes (P=0.002), anisometropia (P=0.034).

CONCLUSION

: Postoperative stereoacuity was better in patients who underwent either optic capture or anterior vitrectomy after posterior continuous curvilinear capsulorhexis, and who didn't develop secondary cataracts or strabismus postoperatively. Furthermore, postoperative BCVA of the affected eyes, and anisometropia influenced the stereoacuity of the patients surgically treated for unilateral developmental pediatric cataracts.

Long-term Outcomes of Undercorrection Versus Full Correction After Unilateral Intraocular Lens Implantation in Children

PURPOSE

To evaluate the impact of full correction vs undercorrection on the magnitude of the myopic shift and postoperative visual acuity after unilateral intraocular lens (IOL) implantation in children.

DESIGN

Retrospective case control study.

METHODS

The medical records of 24 children who underwent unilateral cataract surgery and IOL implantation at 2 to <6 years of age were reviewed. The patients were divided into 2 groups based on their 1-month-postoperative refraction: Group 1 (full correction) -1.0 to +1.0 diopter (D) and Group 2 (undercorrection) ≥+2.0 D. The main outcome measures included the change in refractive error per year and visual acuity for the pseudophakic eyes at last follow-up visit. The groups were compared using the independent groups t test and Wilcoxon rank sum test.

RESULTS

The mean age at surgery (Group 1, 4.2±0.9 years, n=12; Group 2, 4.5±1.0 years, n=12; P=.45) and mean follow-up (Group 1, 5.8±3.7 years; Group 2, 6.1±3.5 years; P=.69) were similar for the 2 groups. The change in refractive error (Group 1, -0.4±0.5 D/y; Group 2, -0.3±0.2 D/y; P=.70) and last median logMAR acuity (Group 1, 0.4; Group 2, 0.4; P=.54) were not significantly different between the 2 groups.

CONCLUSIONS

We did not find a significant difference in the myopic shift or the postoperative visual acuity in children aged 2 to <6 years of age following unilateral cataract surgery and IOL implantation if the initial postoperative refractive error was near emmetropia or undercorrected by 2 diopters or more.

Long-term outcome of primary versus secondary intraocular lens implantation after simultaneous removal of bilateral congenital cataract

BACKGROUND

Long-term outcomes of intraocular lens (IOL) implantation for congenital cataract in children under 2 years old are still undetermined.

METHODS

We retrospectively reviewed all cases of bilateral congenital cataract who had undergone simultaneous bilateral cataract removal with posterior capsulotomy and central anterior vitrectomy between 1990 and 2010. Patients randomly underwent primary IOL implantation or secondary IOL implantation after a period of contact lens wear. The two groups were compared for visual outcome and complications during follow-up.

RESULTS

Cataract removal and primary IOL implantation was performed in 30 eyes (15 patients; nine males, six females) at a mean age of 6.8 ± 4.2 months. After 79.31 ± 63.4 months, best-corrected visual acuity (BCVA) was 0.53 ± 0.36 EDTRS LogMAR. In 36 eyes (18 patients, 11 males, seven females) the lens was removed at a mean age of 5.42 ± 2.80 months, and after 32.0 ± 6.1 months of contact lens utilization, secondary IOL implantation was performed. After 109.0 ± 33.8 months, BCVA was 0.54 ± 0.4 ETDRS LogMAR. The association between age at surgery and final visual acuity and the difference between the two groups concerning type of cataract at baseline, BCVA and refractive error at last visit, incidence of posterior capsular opacification, glaucoma, strabismus, and nystagmus during follow-up were not significant (p > 0.05). Myopic shift was more frequent in eyes undergone primary IOL implantation (p < 0.001).

CONCLUSIONS

Similar visual outcome and complications were observed during long-term follow-up after both primary and secondary IOL implantation following simultaneous bilateral congenital cataract removal with posterior capsulotomy and central anterior vitrectomy.

Refractive shift in pseudophakic eyes during the second decade of life

PURPOSE

To evaluate the refractive shift in pseudophakic eyes of children after their 10th birthday.

SETTING

Storm Eye Institute, Charleston, South Carolina, USA.

DESIGN

Case series.

METHODS

One eye of each patient with at least 2 refractions at a minimum of a 1-year interval after the 10th birthday was analyzed.

RESULTS

One hundred fourteen pseudophakic eyes (114 patients) were identified. The mean initial refraction was -0.65 diopter (D) ± 2.27 (SD) and the mean final refraction, -1.78 ± 2.82 D. The mean shift in refraction was -1.13 ± 1.36 D; the mean shift in refraction per year was -0.30 ± 0.38 D. Postoperative refraction could be predicted by regression analysis (P<.001). There was a myopic shift in refraction in 86.8% of eyes; 64.0% of eyes had up to a 0.50 D myopic shift per year. Age at the time of intraocular lens (IOL) implantation (before or after 10 years of age) did not influence the refractive shift in pseudophakic eyes of children after their 10th birthday. However, the refractive shift was significantly different between black patients and white patients (P=.006). In unilateral cases, 27 eyes had refraction data available for the fellow eye. The mean refractive shift per year was -0.19 D in the operated eye and -0.22 D in the fellow eye (P=.67).

CONCLUSION

A myopic shift in refraction continued in children after 10 years of age, which has important implications for the use of multifocal IOLs in preteens and teenagers and for IOL power selection.

Long-term visual acuity and initial postoperative refractive error in pediatric pseudophakia

OBJECTIVE

To examine the long-term best-corrected visual acuity (BCVA) in children who, during the amblyogenic period, underwent cataract extraction with intraocular lens (IOL) implantation and to see if initial postoperative refractive error following cataract extraction correlates with long-term BCVA.

DESIGN

Retrospective chart review.

PARTICIPANTS

Thirty-six eyes of 26 patients were included in the study. At least 2 years of follow-up, an age , 8.5 years at time of IOL implantation, an ability to participate in subjective visual acuity measurement, and an absence of congenital glaucoma and significant trauma were required for inclusion in the study.

METHODS

Retrospective review of pseudophakic patients' charts at a tertiary care centre, with attention to initial and long-term pseudophakic refractive error, long-term BCVA, total myopic shift, length of follow-up, age at IOL implantation, and unilateral or bilateral cataract extraction with IOL implantation.

RESULTS

Initial pseudophakic spherical equivalent (SE) showed a significant nonlinear relationship with most recentBCVAin unilateral cases and no relationship in bilateral cases (interaction p 0.001). Unilateral cases with initial pseudophakic SE between +1.75 D and +5.00 D showed better long-term BCVA than those with values below +1.75 D or above +5.00 D; this was irrespective of the refractive error of their fellow eye.

CONCLUSIONS

In patients receiving lens implants in the first 8 years of life, we recommend aiming for low early postoperative hyperopia, taking into consideration each patient's situation and age.

Evolution of postoperative astigmatism after large incision PMMA lens implantation in children

PURPOSE

To investigate the evolution of postoperative astigmatism after cataract extraction and lens implantation in children through a 6.5 mm limbal incision.

METHODS

This is a retrospective longitudinal study of consecutive pediatric patients with adequate follow-up who underwent cataract extraction with intraocular lens implantation through a 6.5 mm limbal incision. Preoperative and 3-month postoperative astigmatism and spherical equivalent were compared.

RESULTS

A total of 92 eyes of 73 children met the inclusion criteria. The mean cylindrical correction on the first postoperative day was 6.6 ± 2.3 D (range, 1.00-13.00 D). This dropped to 1.9 ± 1.7 D between 2 and 4 weeks and 1.2 ± 1.0 D (range, 0-3.25 D) by 3 months postoperatively. The mean spherical equivalent was +0.5 D on the first postoperative day and did not change significantly during the follow-up period. The mean astigmatism preoperatively (1.2 ± 0.8 D) and 3 months postoperatively (1.2 ± 1.0 D) were not statistically different (p = 0.9). There was no statistically significant change in astigmatism between 1 and 3 months and 1 and 2 years (p = 0.16, n = 33).

CONCLUSIONS

Large cylindrical refractive errors after pediatric cataract surgery through a 6.5 mm limbal incision resolve postoperatively within 3 months.

[Advantages of the bag-in-the-lens intraocular lens in pediatric cataract surgery]

OBJECTIVE

Evaluate the advantages of the bag-in-the-lens intraocular lens in children undergoing cataract surgery.

PATIENTS AND METHODS

This prospective study included 54 eyes of 37 children and babies (age, 2 months to 14 years), consecutively operated on between December 1999 and January 2008 for unilateral or bilateral cataract using the "bag-in-the-lens" intraocular lens. Slit-lamp examination, intraocular pressure, visual acuity, and refraction were followed to the best possible degree over time.

RESULTS

The mean age of the 37 children at the last consultation visit was 8.3+/-4.9 years. The mean visual acuity improved from 0.2+/-0.1 to 0.8+/-0.3. On the other hand, visual acuity improvement in children presenting hyperplastic persistence of the vitreous was less favorable with a postoperative average visual acuity of 0.14+/-0.18. The mean postoperative refraction in 13 children (26 eyes) operated on for bilateral cataract was 0.5+/-1.5 D for eyes showing axial lengths with substantial variation. The refraction was stable over time in children over 2 years of age. Once the implant was positioned correctly, the remaining epithelial cells of the lens did not migrate toward the visual axis, which was the case in 93.8% of all eyes and in 100% of children over 1 year of age.

CONCLUSIONS

The "bag-in-the-lens" implant is particularly indicated in children in whom posterior rhexis and optic capture have been recommended since 1994. The implantation minimizes the use of anterior vitrectomy in pediatric cataract surgery, limiting it to those eyes presenting a proliferative hyperplastic vitreous.

Accuracy of biometry in pediatric cataract extraction with primary intraocular lens implantation

PURPOSE

To determine the accuracy of predicted postoperative refractive outcomes in pediatric patients having cataract surgery with intraocular lens (IOL) implantation and to compare them with other variables historically considered important in cataract surgery.

SETTING

Tertiary care referral hospital.

METHODS

This retrospective review comprised 203 eyes of 153 consecutive pediatric patients (< or = 18 years old) having cataract extraction with primary posterior chamber IOL implantation in the capsular bag. All cases were performed by 1 of 2 surgeons, and all refractions were performed manually by an experienced pediatric ophthalmologist using a retinoscope.

RESULTS

In all patients, the mean absolute value (MAE) of the prediction error was 1.08 diopters (D) +/- 0.93 (SD). Age at time of surgery and corneal (K) mean curvature were significantly correlated with the absolute value of the prediction error (P = .0006 and P = .0088, respectively). A multiple regression model showed that age at time of surgery and K mean curvature were the only 2 variables significantly associated with MAE; axial length, formula, surgeon, and A-scan type were not significantly associated with prediction error.

CONCLUSIONS

Data from 203 consecutive primary pediatric IOL implantations showed the heterogeneous nature of the variables involved in predictions of refractive outcomes in this population. The complexities of this issue support the need for specific methods of measurement and an IOL calculation formula for the pediatric population.

Accuracy of IOL calculations in children: a comparison of immersion versus contact A-scan biometery

PURPOSE

To evaluate the accuracy of pediatric IOL calculations performed under general anesthesia by using immersion A-scan biometry and to compare the results to those obtained using contact A-scan biometry.

METHODS

A retrospective review of 203 consecutive cases of pediatric cataract extraction with primary IOL implantation within the capsular bag; mean patient age was 5.52 +/- 4.19 years (range, 18 days to 18 years). Axial length measurements were performed with the contact A-scan biometry in 138 eyes, whereas immersion technique biometry was used in the remaining consecutive 65 eyes. Preoperative predictive target refraction was compared with the refractive result obtained at the 2-month postoperative visit.

RESULTS

The mean of the absolute value lens prediction error for all eyes was 1.08 +/- 0.93 D from the desired postoperative refractive result. Lens prediction error for the contact A-scan subgroup was 1.11 +/- 0.90 D, whereas the immersion A-scan subgroup was less at 1.03 +/- 0.98 D. This result was not statistically significant (p = 0.6442). Statistically significant correlations were found between increased lens prediction error and age at time of surgery or corneal curvature.

CONCLUSIONS

This retrospective, noncomparative pilot study showed no significant difference in IOL prediction error when comparing the postoperative refractive results obtained with immersion versus contact A-scan biometry in pediatric IOL calculations.

Intraocular lens power calculation in children

With improving surgical technique and equipment, the acceptable age for placing an intraocular lens in infants and children is becoming younger. The tools for predicting intraocular lens power have not necessarily kept up, as current theoretical and regression intraocular lens power prediction formulas are largely based on adult eyes at axial lengths, anterior chamber depth, and keratometric values much different than those seen in infants. In addition, the adult eye has matured and is no longer growing, whereas the eyes of infants and children may continue to note changes in axial length, keratometric values, and possibly optical characteristics. Another source of error in intraocular lens power selection that is more likely to occur in pediatric patients than in adult patients is inaccuracy in measurement of axial length or keratometric power. A review of current tools and considerations for intraocular lens power prediction in infants and children is presented.

Paediatric pseudophakia: analysis of intraocular lens power and myopic shift

BACKGROUND

At the Alberta Children's Hospital, the authors have been performing paediatric cataract extraction with intraocular lens (IOL) implant for over 10 years. The authors examined the amount of myopic shift that occurs in various age groups and cataract types, in order to evaluate the success of predicting the appropriate power of IOL to implant.

METHODS

This study is a retrospective review children undergoing small incision posterior chamber foldable IOL implantation between age 1 month and 18 years, from 1995 to 2005. 163 eyes of 126 patients underwent surgery. All patients were followed for a minimum of 6 months postoperatively. The children were divided into four groups at time of surgery: Group A: 1-24 months, Group B: 25-48 months, Group C: 49-84 months, Group D: 85 months-18 years.

RESULTS

The mean target refraction for the groups were: Group A: +6.37 D, Group B: +4.66 D, Group C: +1.95 D, and Group D: +0.97 D. Children under 4 years experienced the most myopic shift and the largest mean rate of refractive change per year. Mean change Group A: -5.43 D, Group B: -4.16 D, Group C: -1.58 D, Group D: -0.71 D. Eighty-nine per cent of patients with unilateral cataracts had a postoperative refraction within 3.00 D of the fellow eye at last follow-up visit (mean=3.16 years).

CONCLUSIONS

The rate of myopic shift is high in children under age 4 years at time of surgery, shifting as much as -12.00 D. The mean postoperative target refraction should probably be increased from previous literature recommendations. The patient's age at time of cataract surgery and the refractive power of fellow eye are all factors to consider when deciding what power IOL to surgically implant in a paediatric patient.

Cataractes congénitales unilatérales opérées précocement : devenir réfractif à long terme

PURPOSE

Predict long-term refractive changes after primary lens implantation for unilateral congenital cataract in order to know the intraocular lens power to use to obtain best functional results.

METHODS

This retrospective study analyzed 53 children with unilateral congenital cataract operated on with primary intraocular lens implantation, with a mean follow-up of 6.8 years. The mean age at surgery was 2.98 years.

RESULTS

The mean myopic shift per year was -0.83 D/year. Children operated on before the age of 2 years had a mean myopic shift of -9.15 D, and others presented -2.13 D. The variability of myopic shift decreased with age. The mean visual acuity was +0.25 logMAR. Four intraocular lenses were changed because of substantial anisometropia.

CONCLUSION

Early surgery with primary implantation and intensive amblyopia treatment provide good long-term visual results. Long-term refractive changes of very young children operated on for unilateral congenital cataract is extremely variable. Changing the intraocular lens is conceivable when substantial anisometropia slows down amblyopia rehabilitation.

Refractive outcomes after primary intraocular lens implantation in infants

BACKGROUND

Intraocular lens (IOL) implantation is becoming increasingly accepted as a primary procedure in infants.

AIM

To evaluate the accuracy of IOL power calculation, the rate of myopic shift and the refractive outcome after primary IOL implantation in infants aged <12 months at the time of cataract surgery.

METHOD

A retrospective case review of 25 patients (8 with bilateral cataracts and 17 with unilateral cataracts) who underwent cataract surgery with primary IOL implantation at <12 months of age. Outcomes measured were actual early postoperative refraction, lens power calculation error, myopic shift and refractive outcome.

RESULTS

In 83% of cases, actual postoperative refraction was within 2 dioptres (D) of the target refraction. Lens power calculation error did not depend on axial length, age at surgery or target refraction. Mean (SD) myopic shift was 5.43 (3.7) D in the first 12 months after surgery, but was significantly greater when surgery was performed at <10 weeks of age.

CONCLUSION

This study demonstrates that IOL power can be calculated with reasonable accuracy in infants using current formulas. Factors such as age at the time of surgery, axial length, whether surgery is unilateral or bilateral, and the presence of systemic pathologies do not seem to influence the accuracy of lens power calculation or myopic shift up to 36 months of age.

Long-term refractive change after intraocular lens implantation in childhood

BACKGROUND

To determine refractive change occurring with age in children who had cataract removal with intraocular lens implantation and in whom the immediate postoperative refraction was targeted either to match the refractive error of the opposite eye in unilateral cases, or for only a small refractive error when surgery was bilateral.

METHODS

Retrospective review of the refractive error over time in 36 eyes of 25 children who underwent cataract removal (11 bilateral) with insertion of an intraocular lens from 1987 to 1998 and who had at least 4 years follow-up, but no glaucoma.

RESULTS

Mean age at surgery was 5.5 years (median 5.7 y, range 1.3-12 y), with a mean follow-up of 8 years (median 6 y, range 4-16 y). The average refraction followed a logarithmic decline with age. Although eyes with unilateral surgery had a slightly faster rate of change and lower final refraction than did eyes with bilateral surgery, this difference was not statistically significant. Variation from this trend was also observed in 3 patients. When the hyperopic refractive error created immediately after surgery was small, children usually became significantly myopic when older, often creating anisometropic myopia in unilateral cases.

INTERPRETATION

When implanting intraocular lenses bilaterally one should aim for a significant but balanced hyperopic correction immediately postoperatively in young patients, anticipating that there will be emmetropization with aging. Parents should be warned that variations can occur.

Update on the surgical management of pediatric cataracts

The treatment of pediatric cataracts is rapidly evolving, and the visual prognosis for infants and children with cataracts is improving, due in part to earlier surgery, increased frequency of intraocular lens (IOL) implantation, more effective amblyopia therapy following surgery, and better forms of optical correction. A surgeon treating a child with a cataract is faced with An assortment of therapeutic dilemmas such as whether an IOL should be implanted, whether foldable lenses are appropriate, and whether the posterior capsule should be opened during surgery. Although the surgery can be technically difficult in small and unforgiving eyes, it is often the easy part as treatment decisions and results have lifelong implications. The visual system, which is immature at birth, has a latent period of approximately 6 weeks before it becomes sensitive to deprivation, and binocular vision first appears at approximately 3 months of age. It is therefore imperative that infants with visually significant congenital cataracts receive prompt treatment during the sensitive periods to decrease the risk of developing amblyopia or binocular abnormalities. An ideal time for early surgical intervention resulting in few complications and maximal visual outcome has not been identified with certainty. Perhaps the greatest overall change in the approach to the surgical treatment of pediatric cataracts has been the adaptation of techniques used in adult cataract surgery. This article focuses on the methods currently used in the management of pediatric cataracts.

Long term results of primary posterior chamber intraocular lens implantation for congenital cataract in the first year of life

AIM

To document the long term outcome of congenital cataract surgery with primary posterior chamber (PC) lens implantation in the first year of life.

METHOD

A retrospective review of congenital cataract surgery in the first year of life with PC lens implantation in 18 infants, eight with unilateral and 10 with bilateral cataract. The average age at surgery was 15 weeks (range 3-44 weeks). The mean follow up was 95 months (range 60-139 months).

RESULTS

The best outcomes were in the bilateral group where 50% of eyes achieved 6/18 or better, with a best acuity of 6/9. Acuities were poor in the unilateral group where only 38% achieved 6/60 or better, with a best acuity of 6/24. There was a mean refractive shift between first refraction after surgery and refraction at 36 months after surgery of -3.44 dioptres with a very wide range (+2.00 to -15.50). There was a significantly greater myopic shift in the unilateral cases. Many eyes in both groups continued to show an increasing myopic shift between 36 months after surgery and their final recorded refraction. The main complications were amblyopia, especially in unilateral cataracts, and posterior capsular opacification. Amblyopia was most probably related to a combination of early onset of dense cataract in this young age group, late presentation for initial surgery, delay in capsulotomies, and imperfect compliance with a rigorous occlusion regime.

CONCLUSION

Intraocular lens implantation in infants less than 1 year of age is generally a safe procedure. The spread of final refractive error was very wide. Final refraction in the unilateral group was significantly more myopic than the bilateral group. Final acuities were often disappointing especially in the unilateral group.

Secondary artisan phakic intraocular lens for correction of progressive high myopia in a pseudophakic child

An 8-week-old infant underwent unilateral cataract extraction and posterior chamber intraocular lens implantation for total cataract in the left eye. After surgery, a residual progressive myopic error was observed, ranging from -4.5 diopters (D) 6 months after the operation to -14.0 D at the age of 3 years. Because of parental noncompliance for contact lens and spectacles use, secondary implantation of Artisan phakic IOL of -14.0 D power was performed. No intra- or postoperative complications were observed. Nine months after this second operation, myopia diminished to -3.25 D.

Cataracts in children

Bilateral congenital cataract is the most common cause of treatable childhood blindness. Nuclear cataract is usually present at birth and is nonprogressive, whereas lamellar cataract usually develops later and is progressive. Surgery must be performed promptly in cases with dense congenital cataract; if nystagmus has developed, the amblyopia is irreversible. A treatment regimen based on surgery within 2 months of birth combined with prompt optical correction of the aphakia and aggressive occlusion therapy with frequent follow-up has been successful in unilateral and bilateral cases. Both anterior and posterior capsulorhexes are performed in most children. Intraocular lens implantation can be performed safely in children older than 1 year. Anterior dry vitrectomy is recommended in preschool children to avoid after-cataract. Opacification of the visual axis is the most common complication of cataract surgery in children. Secondary glaucoma is the most sight-threatening complication and is common if surgery is performed early. Life-long follow-up is essential in these cases.

Accuracy of intraocular lens calculations in infants and children undergoing cataract surgery

PURPOSE

We sought to evaluate the accuracy of intraocular lens calculations in children undergoing cataract extraction with intraocular lens (IOL) implantation.

METHODS

This was a retrospective review of 101 consecutive cases of pediatric cataract extraction with posterior chamber IOL. Median age at the time of surgery was 4.8 years, and 23 of the children were younger than 2 years of age. Initial IOL calculations were made using either the SRK II or SRK T formulas. Preoperative predictive data were compared with the refractive result obtained at the 2-month postoperative visit. Prediction error was calculated for each patient, and lens calculation errors were back-calculated for each of 4 commonly used IOL calculation formulas, including the SRK II, SRK T, Holladay I, and Hoffer Q.

RESULTS

The mean prediction error for all patients was 0.30 D. Despite this level of overall accuracy, significant variability did occur with outcomes ranging from -4.06 D to + 3.86 D of the desired spherical equivalent. Mean absolute prediction error was 1.16 D with no significant difference between the SRK II and SRK T formulas. Lens calculation errors predicted by each of the 4 formulas studied demonstrated a high degree of variability with the SRK II being the least variable and the Hoffer Q being the most variable, particularly among the youngest group of children with the axial lengths less than 19 mm.

CONCLUSIONS

The accuracy of commonly used IOL calculation formulas is generally reasonable but highly variable within the pediatric population, Newer theoretic IOL calculation formulas did not outperform older regression models.

Astigmatism after small-incision clear corneal cataract extraction and intraocular lens implantation in children

PURPOSE

To investigate the magnitude of postoperative astigmatism in children having cataract extraction with intraocular lens (IOL) implantation through a 3.0 mm superior clear corneal incision.

SETTING

Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA.

METHODS

This retrospective chart review comprised all pediatric patients having cataract surgery with IOL implantation through a 3.0 mm clear corneal incision from 1997 to 2002. One hundred two eyes of 75 patients were included. All refractions were performed manually by an experienced pediatric ophthalmologist.

RESULTS

The mean postoperative retinoscopic cylinder in all patients was 0.63 diopter (D) (range 0.0 to 4.50 D) at 1 month, 0.40 D (range 0.0 to 1.75 D) at 6 months, and 0.51 D (range 0.0 to 2.50 D) at 1 year. Patients aged 0 to 36 months at the time of surgery had a mean postoperative cylinder of 0.22 D at 1 month, 0.03 D at 6 months, and 0.21 D at 1 year. Patients between 36 months and 6 years of age at surgery had a mean refractive cylinder of 0.50 D, 0.38 D, and 0.75 D, respectively. Patients older than 6 years at surgery had a mean refractive cylinder of 0.94 D, 0.75 D, and 0.76 D, respectively.

CONCLUSIONS

Small-incision clear corneal cataract extraction with IOL implantation in children led to minimal postoperative astigmatism that remained stable over time. Less astigmatism was observed in children having surgery before they were 36 months old.

Pediatric cataract surgery and intraocular lens implantation: practice styles and preferences of the 2001 ASCRS and AAPOS memberships

A survey of pediatric cataract surgery and intraocular lens (IOL) implantation practice patterns of adult and pediatric cataract surgeons was performed in October 2001. Questionnaires were distributed to the American Society of Cataract and Refractive Surgery and the American Association for Pediatric Ophthalmology and Strabismus. The overall return rate was 12.6% and 41.0%, respectively. Results show that pediatric cataract surgery with IOL implantation is being performed at a younger age than 8 years ago. Also, pediatric cataract surgery practice patterns are evolving in step with advances in adult surgery but with notable differences.

Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members

BACKGROUND

To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization.

METHODS

All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction.

RESULTS

In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization.

CONCLUSIONS

Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.