Virender Sachdeva1, Sushma Katukuri2, Ramesh Kekunnaya3, Merle Fernandes4, Mohammed Hasnat Ali5. 1. Nimmagada Prasad Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India. Electronic address: vsachdeva@lvpei.org. 2. Jasti V. Ramanamma Children Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India. 3. Jasti V. Ramanamma Children Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India; Child Sight Institute and Jasti V. Ramanamma Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India. 4. Nimmagada Prasad Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India. 5. Centre for Clinical Epidemiology and Biostatistics, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India.
Abstract
PURPOSE: Initial undercorrection of intraocular lens (IOL power) is a common practice in children undergoing pediatric cataract surgery. However, the long-term refractive status of these children is largely unknown. The purpose of this study is to analyze the long-term refractive status of these children. DESIGN: Retrospective observational study. METHODS: We analyzed records of children (<7 years of age) who underwent cataract surgery with a primary IOL implantation and had completed follow-up to ≥7 years of age. Data were collected regarding demographics, etiology of cataract, method of undercorrection, and serial follow-up refractions. Prediction error was defined as refractive error minus emmetropia. The main outcome measure was prediction error at 7 years of age. RESULTS: Eighty-four eyes of 56 children (28 unilateral and 28 bilateral cases) met the study criteria. The median age at surgery was 3.3 years (interquartile range 2.7-5 years), and the median follow-up period was 3.75 years. At 7 years of age, the median absolute prediction was 1.5 diopters (interquartile range 0.75-2 diopters). Seven of 84 (8.3%) children achieved emmetropia while an equal proportion were myopic (45%) or hypermetropic (46%). Prediction error (adjusted for using both eyes) at 7 years of age was not significantly different in any group (P > .05). Maximum myopic shift was observed in children <2 years of age. Age at surgery was the only significant factor that influenced prediction error (â = -0.32; P = .001). CONCLUSION: This study suggests that children undercorrected using guidelines suggested by Enyedi and associates may achieve an acceptable refractive error at 7 years of age. However, in children <2 years of age, more hypermetropia may be observed. More studies are needed to validate various methods of undercorrection and compare with other guidelines.
PURPOSE: Initial undercorrection of intraocular lens (IOL power) is a common practice in children undergoing pediatric cataract surgery. However, the long-term refractive status of these children is largely unknown. The purpose of this study is to analyze the long-term refractive status of these children. DESIGN: Retrospective observational study. METHODS: We analyzed records of children (<7 years of age) who underwent cataract surgery with a primary IOL implantation and had completed follow-up to ≥7 years of age. Data were collected regarding demographics, etiology of cataract, method of undercorrection, and serial follow-up refractions. Prediction error was defined as refractive error minus emmetropia. The main outcome measure was prediction error at 7 years of age. RESULTS: Eighty-four eyes of 56 children (28 unilateral and 28 bilateral cases) met the study criteria. The median age at surgery was 3.3 years (interquartile range 2.7-5 years), and the median follow-up period was 3.75 years. At 7 years of age, the median absolute prediction was 1.5 diopters (interquartile range 0.75-2 diopters). Seven of 84 (8.3%) children achieved emmetropia while an equal proportion were myopic (45%) or hypermetropic (46%). Prediction error (adjusted for using both eyes) at 7 years of age was not significantly different in any group (P > .05). Maximum myopic shift was observed in children <2 years of age. Age at surgery was the only significant factor that influenced prediction error (â = -0.32; P = .001). CONCLUSION: This study suggests that children undercorrected using guidelines suggested by Enyedi and associates may achieve an acceptable refractive error at 7 years of age. However, in children <2 years of age, more hypermetropia may be observed. More studies are needed to validate various methods of undercorrection and compare with other guidelines.