The change in axial length in the pseudophakic eye compared to the unoperated fellow eye in children with bilateral cataracts

Deviations From Age-Adjusted Normative Biometry Measures in Children Undergoing Cataract Surgery: Implications for Postoperative Target Refraction and IOL Power Selection

PURPOSE

To evaluate whether pediatric eyes that deviate from age-adjusted normative biometry parameters predict variation in myopic shift after cataract surgery.

METHODS

This is a single institution longitudinal cohort study combining prospectively collected biometry data from normal eyes of children <10 years old with biometry data from eyes undergoing cataract surgery. Refractive data from patients with a minimum of 5 visits over ≥5 years of follow-up were used to calculate myopic shift and rate of refractive growth. Cataractous eyes that deviated from the middle quartiles of the age-adjusted normative values for axial length and keratometry were studied for variation in myopic shift and rate of refractive growth to 5 years and last follow-up visit. Multivariable analysis was performed to determine the association between myopic shift and rate of refractive growth and factors of age, sex, laterality, keratometry, axial length, intraocular lens power, and follow-up length.

RESULTS

Normative values were derived from 100 eyes; there were 162 eyes in the cataract group with a median follow-up of 9.6 years (interquartile range: 7.3-12.2 years). The mean myopic shift ranged from 5.5 D (interquartile range: 6.3-3.5 D) for 0- to 2-year-olds to 1.0 D (interquartile range: 1.5-0.6 D) for 8- to 10-year-olds. Multivariable analysis showed that more myopic shift was associated with younger age (P < .001), lower keratometry (P = .01), and male gender (P = .027); greater rate of refractive growth was only associated with lower keratometry measures (P = .001).

CONCLUSIONS

Age-based tables for intraocular lens power selection are useful, and modest adjustments can be considered for eyes with lower keratometry values than expected for age.

Axial Length Change in Pseudophakic Eyes Measured by IOLMaster 700

Purpose

The purpose of this study was to investigate the change in axial length (AL) after cataract surgery measured by swept source optical coherence tomography (IOLMaster 700), and explore ways to eliminate this AL measurement error in pseudophakic eyes.

Methods

Patients with cataract who underwent unilateral phacoemulsification with four types of intraocular lens (IOLs) implantation (Asphina 509M, Tecnis PCB00, enVista MX60, and Acrysof SN60WF) were enrolled. Bilateral AL measurements were performed before and 1 month after cataract surgery utilizing IOLMaster 700. The postoperative AL of the operated eye was evaluated using three different modes (phakic, aphakic, and pseudophakic), and the fellow eye was measured by phakic mode. Associations among the AL change and cataract grade, lens thickness, preoperative AL, or refractive index of IOL were investigated using stepwise multivariate linear regression.

Results

A total of 305 patients with cataract with mean age of 65.97 ± 13.39 years were recruited. The mean postoperative AL was 0.10 mm and 0.21 mm shorter than the pre-operative AL utilizing pseudophakic and phakic modes, respectively (P < 0.001). No significant difference was observed between pre-operative and postoperative AL using aphakic mode (P = 0.264). There were no significant associations among AL change in pseudophakic eye and cataract grade, lens thickness, pre-operative AL, or refractive index of IOL (P > 0.05).

Conclusions

A correction factor of 0.10 mm is suggested to eliminate AL measurement error of IOLMaster 700 in pseudophakic eyes before further improvement of AL measurement accuracy.

Translational Relevance

Our study may help to eliminate the AL measurement error of IOLMaster 700 in pseudophakic eyes.

Evaluation of changes in axial length after congenital cataract surgery

PURPOSE

To investigate the relationship between lens status and axial length (AL) in patients operated for unilateral and bilateral congenital cataract.

SETTING

Yüzüncü Yıl University, Ophthalmology Clinic, Van, Turkey.

DESIGN

Retrospective study.

METHODS

Records of patients who underwent surgery for unilateral or bilateral congenital cataract were analyzed. The patients were separated into three groups: bilateral aphakic, bilateral pseudophakic, and unilateral. The unilateral group was subdivided into the operated cataract eyes (unilateral aphakic and unilateral pseudophakic) and unoperated fellow phakic eyes. The patients' age at surgery, follow-up time, preoperative and postoperative AL measurements, change in AL, and monthly growth rate were evaluated.

RESULTS

The bilateral aphakic group included 40 eyes of 20 patients, the bilateral pseudophakic group included 103 eyes of 54 patients, and the unilateral group included 40 eyes of 20 patients. The mean age at time of surgery in these groups was 8.17 months ± 10.65 (SD), 42.47 ± 43.81 months, and 42.47 ± 43.81 months, respectively. There were no significant differences in preoperative AL, postoperative AL, change in AL, or monthly growth rate between the aphakic and fellow phakic eyes in the unilateral group (P > .05). There were also no significant differences between unilateral pseudophakic eyes and fellow phakic eyes in the unilateral group with respect to preoperative AL or change in AL, but there were significant differences in final AL and monthly growth rate (P < .05).

CONCLUSIONS

Various factors can affect axial elongation. The monthly growth rate was lower in pseudophakic eyes compared with phakic eyes. Experimental studies are required to understand the mechanism underlying this effect.

Relationship between preoperative axial length and myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation at the National Institute of Ophthalmology of Peru, 2007-2011

Objective

To determine the relationship between the preoperative axial length and the myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation and other related factors.

Methods

In this retrospective cohort study, the axial length was measured and assigned into 2 groups (>21.5 mm and ≤21.5 mm), visual axis obscuration, laterality of cataract, age of surgery and follow-up time were assessed and compared to the myopic shift.

Results

The mean myopic shift was 3.6 (standard deviation [SD]: 2.3) diopters (D) in all patients; 3.2 (3.3) and 3.9 (3.2) D for each group respectively (p=0.359). In unilateral cataracts the mean myopic shift was 6.3 D and in bilateral cases was 3.0 D (p=0.001). In bilateral cataracts, the shift was 2.6 D (SD: 2.0) and 3.4 D (SD: 1.8), respectively (p=0.098).

Conclusion

There was no relationship between the initial axial length and the myopic shift in all patients. Unilateral cataracts had a greater myopic shift over 3 years.