Globe Axial Length Growth at Age 5 Years in the Infant Aphakia Treatment Study

Rare micropupil secondary to congenital cataract surgery favoring the development of the affected eye: a case report

BACKGROUND

Congenital microcoria has been extensively reported and usually leads to visual dysfunction or blindness. However, micropupil development secondary to cataract surgery has never been reported. Here, we describe a rare case of micropupil development in infancy that occurred secondary to combined cataract extraction and intraocular lens implantation for treatment of congenital cataract. When the patient reached adulthood, the affected eye not only gained good vision but also showed better ocular development and refractive status than the fellow eye.

CASE PRESENTATION

A 17-year-old boy presented to our outpatient clinic with decreased vision in his left eye related to congenital cataract surgery at 6 months of age. The affected eye had exhibited a pinhole pupil since the third month postoperatively. The condition had been managed with observation and regular monocular occlusion treatment. Upon presentation to our clinic, the best-corrected visual acuity (BCVA) in his fellow eye was 0.0 logMAR(20/20) with a refraction of - 5.75 diopters cylinder/-2.25 diopters sphere, and the BCVA in his affected eye was 0.5 logMAR(20/40) with a refraction of 0.00 diopters. Ophthalmic examination of the affected eye revealed a pinhole pupil (approximately 0.5 mm) with high light reflex sensitivity but no response to pupil-dilating drugs. The patient underwent pupilloplasty of the affected eye under corneal surface anesthesia. Postoperative examination revealed better ocular development in the affected eye than in the fellow eye (axial length: 24.21 vs. 27.02 mm, respectively) as well as better refractive status in the affected eye (BCVA of 0.0 logMAR(20/20) with a refraction of - 2.23 diopters cylinder/-3.00 diopters sphere vs. 0logMAR(20/20) with a refraction of -5.75 diopters cylinder/-2.25 diopters sphere).

CONCLUSIONS

We have reported a rare case of micropupil development secondary to congenital cataract surgery, which is an uncommon complication, especially in children. However, unlike congenital microcoria, the secondary pinhole pupil may have reduced imaging haze and halos, possibly favoring the development of the affected eye. This case provides further insight into the treatment of congenital cataract.

Comparison of the axial growth with multifocal and monofocal intraocular lenses in unilateral pediatric cataract surgery

PURPOSE

To compare axial growth in pediatric cataract patients who underwent multifocal intraocular lens (IOL) implantation without anterior vitrectomy (AV) with that in pediatric patients who underwent monofocal IOL implantation with or without AV.

METHODS

Patients who had unilateral pediatric cataracts and underwent surgery at 3-6 years of age from June 6, 2019, to June 30, 2020, at our institution were prospectively analyzed. The patients were categorized into Group A: multifocal IOL implantation with optic capture in Berger's space without AV; Group B: monofocal IOL implantation with optic capture in Berger's space without AV; and Group C: bag-in-the-lens monofocal IOL implantation with AV. Groups A', B' and C' consisted of the fellow eyes from the respective groups. Axial growth and monthly growth rates were compared among the 3 treatment groups, as well as between the treated eyes and the fellow eyes.

RESULTS

Thirty-one, 23, and 14 children fulfilling the inclusion criteria, respectively, were included in the final analysis. There were no significant differences in patient age at the time of surgery or preoperative axial length (P > 0.05). After a mean follow-up of 35.57 ± 3.78 months, significant differences in the axial growth and the monthly growth rate were observed (P < 0.05), and Group A had the least axial elongation. Comparing treated eyes with fellow eyes, the amount and rate of axial growth were lower in Group A than in Group A' (P < 0.05), no significant differences were found in Group B (P > 0.05), and Group C had greater growth than did Group C' (P < 0.05).

CONCLUSIONS

The implanting multifocal intraocular lenses and maintenance of vitreous body integrity may be protective factors against excessive axial growth in pediatric cataract patients. Clinical trial registration (prospective study): chiCRT1900023155; 2019-05-14.

Association Between Preoperative Ocular Parameters and Myopic Shift in Children Undergoing Primary Intraocular Lens Implantation

Purpose

To evaluate the association between preoperative ocular parameters and myopic shift following primary intraocular lens (IOL) implantation in pediatric cataracts.

Methods

Eyes from pediatric patients undergoing bilateral cataract surgery with primary IOL implantation were included. Eyes were grouped by age at surgery and subdivided into three axial length (AL) subgroups and three keratometry subgroups. Mixed-effects linear regression was utilized to assess the trend in myopic shift among subgroups. Multivariable analysis was performed to determine factors associated with myopic shift.

Results

A total of 222 eyes were included. The median age at surgery was 4.36 years (interquartile range [IQR], 3.16-6.00 years) and the median follow-up was 4.18 years (IQR, 3.48-4.64 years). As preoperative AL increased, a decreased trend was observed in myopic shift and rate of myopic shift (P = 0.008 and P = 0.003, respectively, in the 4 to <6 years old group; P = 0.002 and P < 0.001, respectively, in the ≥6 years old group). Greater myopic shift and rate of myopic shift were associated with younger age at surgery (P = 0.008 and P = 0.008, respectively). Both myopic shift and rate of myopic shift were negatively associated with AL.

Conclusions

Age at surgery and preoperative AL were associated with myopic shift in pediatric cataracts following primary IOL implantation. Adjusting the target refraction based on preoperative AL could potentially improve patients' long-term refractive outcome.

Translational Relevance

This study may help to guide the selection of postoperative target refraction according to age at surgery and preoperative ocular parameters for pediatric cataracts.

A new strategy to calculate the intraocular lens power in congenital cataracts according to age and axial length at implantation

PURPOSE

The purpose of the study was to suggest a new method to calculate the intraocular lens (IOL) power in paediatric cataracts targeting emmetropia at the age of 15 years.

METHODS

Data of children younger than 15 years who underwent cataract surgery with IOL implantation between 2005 and 2020 in the ophthalmological department of Marseille (South of France) was collected retrospectively. A logarithmic regression model was used to predict the axial length growth of the included eyes between implantation and 15 years. The predicted myopic shift served as target refraction to calculate a theoretical IOL power aiming for emmetropia at 15 years. Refractive error with the theoretical lens power was estimated as the spherical equivalent at the last follow-up minus the difference of target refractions between the implanted IOL and the theoretical one. Refractive errors using Dahan, Enyedi and Trivedi guidelines were also estimated and compared to the logarithmic model.

RESULTS

Thirty-five eyes of 26 children were analysed. At the last follow-up, the median age of children was 10 years old and the median spherical equivalent was -1.88 dioptres (D) (IQR -3.81, -0.75). The estimated median refractive errors were 0.18 D (IQR -1.11, 1.42) with the logarithmic formula, -1.47 D (IQR -3.84, -0.65) with Dahan formula, -0.63 D (IQR -2.15, 0.32) with Enyedi formula and 0.38 D (IQR -1.58, 1.07) with Trivedi formula.

CONCLUSION

The estimated refractive error with the new logarithmic formula is the closest to emmetropia at the last follow-up.

Primary versus secondary intraocular lens implantation following removal of congenital/de al of congenital/developmental catar elopmental cataracts: outcomes after acts: outcomes after at least 4 years

BACKGROUND

The aim of this study is to evaluate the long-term outcomes of primary and secondary intraocular lens (IOL) implantation following removal of congenital/developmental cataracts.

METHODS

One hundred and forty-four patients aged under 16 years who were followed up between 2003 and 2021 were analyzed retrospectively. The long-term results of children who underwent surgery before 2 years of age for congenital or developmental cataracts and underwent secondary IOL implantation after 2 years of age and those who underwent cataract surgery with primary IOL implantation after 2 years of age were compared. Patients with traumatic, secondary cataracts and cataracts due to ocular anomalies were not included in the study.

RESULTS

We evaluated 64 patients (mean age 9.5 ± 4.5 years) with secondary IOL implantation and 80 patients (mean age 12.8 ± 4.1 years) with primary IOL implantation in the study. Distance and near best-corrected visual acuities were significantly better in the primary IOL group than the secondary IOL group (p < 0.001). Incidence of strabismus after primary IOL surgery was significantly lower and presence of binocular vision was more often than the secondary IOL group (p = 0.002). There was no significant difference between the two groups in terms of refraction and myopic shift (p = 0.242, p = 0.172, respectively). Mean refractive changes were significant in unilateral cases of secondary IOL group and primary IOL group (p = 0.013, p = 0.049, respectively) and myopic shift was also greater in both groups of unilateral cases than the fellow eyes (p = 0.023, p = 0.012, respectively).

DISCUSSION

Visual outcomes and binocular vision were better, and the incidence of strabismus was also much less in the primary IOL group.

The impact of pre-operative axial length on myopic shift 3 years after congenital and developmental cataract surgery and intraocular lens implantation

Purpose

To investigate the impact of the pre-operative axial length (AL) on myopic shift (MS) 3 years after primary intraocular lens (IOL) implantation in congenital/developmental cataract patients.

Methods

A retrospective study of patients who underwent congenital/developmental cataract surgery and primary IOL implantation at age 2-3 years at EENT Hospital was conducted. All patients were followed up regularly for at least 3 years after surgery. Refractive outcomes, including spherical equivalent (SE) and MS, were collected at each follow-up.

Results

Forty eyes from 40 patients were included. The mean age at surgery was 2.56 ± 0.57 years old, and the mean follow-up time was 3.05 ± 0.22 years. Patients were divided into two groups: Group 1 included 20 patients with longer pre-operative ALs (≥22 mm), and Group 2 included 20 patients with average pre-operative ALs (<22 mm). By the last follow-up, the MS was 2.13 (0.38, 2.63) D in Group 1 and 3.88 (2.85, 5.72) D in Group 2. The post-operative MS in Group 2 was statistically greater than that in Group 1 at 3 years after surgery (P < 0.001).

Conclusion

In congenital/developmental cataract patients who underwent cataract extraction and primary IOL implantation at age 2-3 years, eyes with longer pre-operative ALs had a slower MS than those with average pre-operative ALs 3 years after surgery. This finding could have implications for the target refraction decision in congenital/developmental cataract surgery.

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.

Biometry and corneal aberrations after cataract surgery in childhood

Background

To report long‐term biometric and refractive outcomes in a group of Danish children after surgery for childhood cataract.

Methods

Children between 7 and 18 years who had undergone uni‐ or bilateral cataract surgery at the Department of Ophthalmology, Rigshospitalet, Denmark, were examined in this cross‐sectional study. Swept source optical coherence tomography (OCT) based optical biometry (IOLmaster 700) and anterior tomography (Pentacam) was performed. Healthy fellow eyes from those with unilateral cataract were used as controls.

Results

We included 56 children in the study with a median age at surgery of 43.8 months (1.6–137.6). The amount of higher order aberrations was significantly increased in operated eyes (median root mean square 0.461 μm [range 0.264–1.484]) compared with non‐operated eyes (median root mean square 0.337 μm [range 0.162–0.498], p < 0.001). Younger age at surgery was positively associated with more higher order aberrations at follow‐up (p < 0.001), but we found no significant associations between the amount of higher order aberrations and visual acuity or contrast vision. Longer axial length was associated to glaucoma while shorter axial length was associated to strabismus (p < 0.001).

Conclusions

Eyes operated for childhood cataract have higher order aberrations compared with non‐operated eyes. Higher order aberrations are complex refractive errors that cannot be corrected by normal lenses and may contribute to poor visual outcomes for the children. We found an association between young age at surgery and higher order aberrations.

Outcomes of secondary intraocular lens implantation in the Infant Aphakia Treatment Study

PURPOSE

To report outcomes of secondary intraocular lens (IOL) implantation in the Infant Aphakia Treatment Study (IATS).

SETTING

Multicenter clinical practice.

DESIGN

Secondary analysis of patients enrolled in a randomized clinical trial.

METHODS

Details regarding all secondary IOL surgeries conducted in children enrolled in the IATS were compiled. Visual outcomes, refractive outcomes, and adverse events at the age of 10½ years were evaluated. Comparisons were made with eyes that remained aphakic and with eyes randomized to primary IOL placement.

RESULTS

The study included 114 infants, 57 in the aphakic group and 57 in the primary IOL group; 55 of 57 patients randomized to aphakia with contact lens correction were seen for the 10½-year study visit; 24 (44%) of 55 eyes had secondary IOL surgery. Median age at IOL surgery was 5.4 years (range 1.7 to 10.3 years). Mean absolute prediction error was 1.00 ± 0.70 diopters (D). At age 10½ years, the median logarithm of the minimum angle of resolution visual acuity (VA) was 0.9 (range 0.2 to 1.7), similar to VA in the 31 eyes still aphakic (0.8, range 0.1 to 2.9); the number of eyes with stable or improved VA scores between the 4½-year and 10½-year study visits was also similar (78% secondary IOL eyes; 84% aphakic eyes). For eyes undergoing IOL implantation after the 4½-year study visit (n = 22), the mean refraction at age 10½ years was -3.20 ± 2.70 D (range -9.90 to 1.10 D), compared with -5.50 ± 6.60 D (n = 53, range -26.50 to 3.00 D) in eyes with primary IOL (P = .03).

CONCLUSIONS

Delayed IOL implantation allows a more predictable refractive outcome at age 10½ years, although the range of refractive error is still large.

Cataract surgery contributes to ocular axis growth of aphakic eyes in infants with complex microphthalmos

To observe the ocular axis, visual acuity and intraocular pressure (IOP) of aphakic eye in infants with congenital cataract and complex microphthalmos after first-stage cataract surgery.This retrospective study included infants with congenital cataract and operated at the Qingdao Eye Hospital between January 2010 and December 2014. The infants were divided into 2 groups: preoperative axial length <18 mm (microphthalmos) or ≥18 mm (controls). Follow-up lasted 24 months; visual acuity, axial length, and IOP were evaluated.There were 28 infants (55 eyes) in the microphthalmos group and 35 (61 eyes) in the control group. The preoperative visual acuity was negative for optokinetic nystagmus, while the postoperative visual acuity was positive for optokinetic nystagmus in both groups. The growth rate was higher in the microphthalmos group (1.4 ± 0.8 vs 0.8 ± 0.4 mm/yr, P < .001 vs controls). The axial length was smaller in the microphthalmos group at all time points compared with the control group (all P < .001). There was no changes in IOP in the microphthalmos group from baseline to 24 months (P = .147), but the IOP was slightly decreased in the control group (P = .015).Cataract surgery may contribute to ocular axis growth in infants with complex microphthalmos.

Globe Axial Length Growth at Age 10.5 Years in the Infant Aphakia Treatment Study

PURPOSE

To report the change in globe axial length (AL) from the time of unilateral cataract surgery at age 1-7 months to age 10.5 years for infants enrolled in the Infant Aphakia Treatment Study, and to compare AL growth of operated eyes with that of fellow unoperated eyes.

DESIGN

Comparative case series.

METHODS

AL growth was analyzed relative to treated vs fellow eye, contact lens (CL) vs intraocular lens (IOL), visual acuity (VA) outcome, and the need for surgery for visual axis opacification. Eyes with glaucoma or glaucoma suspect were excluded from the primary analysis but reported separately.

RESULTS

Fifty-seven patients have reliable AL data available at both visits. AL was shorter in treated eyes preoperatively (P < .0001) and at 10.5 years of age (P = .021) but AL growth was not different (4.7 mm, P = .99). The growth (70.2% up to age 5 and 29.8% from age 5 to 10.5) was similar in the CL and the IOL group (P = .79). Eyes grew 4.4 mm when visual acuity (VA) was better than 20/200, and 5.2 mm when VA was 20/200 or worse (P = .076). Eyes receiving additional surgery grew more than eyes not receiving additional surgery (P = .052). Patients with glaucoma showed significantly more eye growth (7.3 mm) than those without glaucoma (4.7 mm) and glaucoma suspects (5.1 mm) (P < .05).

CONCLUSIONS

Eyes with glaucoma or poor VA often grew longer than the fellow eye. Overall, treated eyes grew similarly in the IOL and CL groups and also kept pace with the growth of the fellow eyes.

The role of primary intraocular lens implantation in the risk of secondary glaucoma following congenital cataract surgery: A systematic review and meta-analysis

Objective

This meta-analysis aims to evaluate the incidence of secondary glaucoma in patients under the age of 2 years who underwent congenital cataract surgery with or without primary intraocular lens (IOL) implantation.

Methods

An electronic literature search was performed in Medline, EMBASE, and Web of Science databases to retrieve studies between January 2011 and November 2018. Patients with congenital cataract who did primary IOL implantation, aphakia, or secondary IOL implantation followed by receiving extraction surgery were included in this study. Relevant studies meeting defined eligibility criteria were selected and reviewed systematically by meta-analysis. Long-term incidences of secondary glaucoma, which developed at least one year after cataract surgery, were considered and discussed as clinical outcomes in each cohort. The pooled data were analyzed according to a random effects model.

Results

Eight publications involving 892 eyes were included in the current meta-analysis. In the general population of eyes with congenital cataract, the long-term incidence of secondary glaucoma was lower (P = 0.06) in eyes with primary IOL (9.5%) than in eyes without primary IOL (15.1%), including aphakia and secondary IOL. The pooled risk ratio (RR) favors primary IOL implantation in all patients (RR = 0.63). For bilateral congenital cataract, the incidence was 6.7% in eyes with primary IOL implantation, which is significantly lower than the 16.7% in eyes with aphakia and secondary IOL implantation (P<0.05, RR = 0.44). However, for unilateral congenital cataract surgery, the incidence was very similar in eyes with and without primary IOL (12.4% vs 12.0%, P = 0.61, RR = 0.87).

Conclusions

In patients under 2 years of age, primary IOL implantation for bilateral congenital cataract surgery is associated with a lower risk of secondary glaucoma.

Evaluation of eye-related parameters and adverse events of rigid gas permeable contact lens and spectacles correction in infants with monocular aphakia after congenital cataract surgery: a retrospective clinical study

Background

Congenital cataract is currently one of the leading blindness-causing eye diseases in children. Surgical treatment only opens the visual pathway for children. The postoperative recovery of visual function is also dependent on effective optical correction and visual function training. In this study, we analyzed the changes in eye-related parameters, adverse events and the annual cost of rigid gas permeable contact lens (RGPCL) and spectacles correction in infants with monocular aphakia after congenital cataract surgery.

Methods

To analyze the postoperative visual acuity, strabismus, nystagmus, myopic shift, globe axial length growth, adverse events, patient adherence to patching, and annual cost for patients with unilateral congenital cataract who underwent cataract surgery. Rigid gas permeable contact lenses or spectacles were used to correct aphakia after congenital cataract.

Results

Of the 49 patients, 20 patients with unilateral aphakia who used RGPCL were in group 1. Group 2 comprised 14 patients with persistent fetal vasculature (PFV) who used RGPCL, and there were 15 patients with spectacles in group 3. In group 1, there were important improvements in visual acuity, strabismus and nystagmus. In groups 2 and 3, there were no significant improvements in visual acuity, strabismus or nystagmus. Patients with a good adherence to patching had better visual acuity after the operation than patients who did not, in groups 1 and 3. There were no significant differences in myopic shift or rate of globe axial length growth among the 3 groups. No patients in group 1 had ocular disease that affected visual acuity. The mean annual expenses of the RGPCL group was 3965 yuan, and the mean annual cost of spectacles was 1140 yuan to 2500 yuan.

Conclusion

RGPCL is a safe and effective optical correction method for patients with monocular aphakia after congenital cataract surgery. Spectacles are not an ideal optical correction. Using RGPCL to correct patients with PFV, the final visual acuity improved, but the difference was not statistically significant. There were no improvements in strabismus or nystagmus in patients with PFV.

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.

Analysis of Factors Associated with the Ocular Features of Congenital Cataract Children in the Shanghai Pediatric Cataract Study

Purpose

To investigate the ocular features of children with congenital cataract in a tertiary referral eye center in East China.

Methods

We retrospectively reviewed the clinical data of congenital cataract children who underwent cataract surgery between April 2009 and April 2014 at the Eye and ENT Hospital of Fudan University and identified factors associated with the axial length (AXL) and corneal curvature (K value).

Results

We included 493 children, 210 with unilateral and 283 with bilateral cataract. The mean AXL was 22.03 ± 1.97 mm and the mean K value was 43.61 ± 1.86 D. Age showed a linear correlation with AXL in unilateral cataract eyes and a logarithmic correlation with AXL in bilateral cataract eyes (both P < 0.001). AXL was longer and the K value was smaller (both P < 0.01) in boys than in girls after adjusting for age and cataract laterality. AXL was longer in unilateral cataract eyes than in bilateral cataract eyes after adjusting for age and gender (P = 0.004). In children with unilateral cataract, AXL was significantly longer in the affected eye than in the contralateral eye (P < 0.001).

Conclusion

Age, gender, and cataract laterality together contribute to the development of ocular features of congenital cataract children, especially for AXL.

Anisometropia at Age 5 Years After Unilateral Intraocular Lens Implantation During Infancy in the Infant Aphakia Treatment Study

PURPOSE

To report the prevalence of anisometropia at age 5 years after unilateral intraocular lens (IOL) implantation in infants.

DESIGN

Prospective randomized clinical trial.

METHODS

Fifty-seven infants in the Infant Aphakia Treatment Study (IATS) with a unilateral cataract were randomized to IOL implantation with an initial targeted postoperative refractive error of either +8 diopters (D) (infants 28 to <48 days of age) or +6 D (infants 48-210 days of age). Anisometropia was calculated at age 5 years. Six patients were excluded from the analyses.

RESULTS

Median age at cataract surgery was 2.2 months (interquartile range [IQR], 1.2, 3.5 months). The mean age at the age 5 years follow-up visit was 5.0 ± 0.1 years (range, 4.9-5.4 years). The median refractive error at the age 5 years visit of the treated eyes was -2.25 D (IQR -5.13, +0.88 D) and of the fellow eyes +1.50 D (IQR +0.88, +2.25). Median anisometropia was -3.50 D (IQR -8.25, -0.88 D); range -19.63 to +2.75 D. Patients with glaucoma in the treated eye (n = 9) had greater anisometropia (glaucoma, median -8.25 D; IQR -11.38, -5.25 D vs no glaucoma median -2.75; IQR -6.38, -0.75 D; P = .005).

CONCLUSIONS

The majority of pseudophakic eyes had significant anisometropia at age 5 years. Anisometropia was greater in patients that developed glaucoma. Variability in eye growth and myopic shift continue to make refractive outcomes challenging for IOL implantation during infancy.