Refractive changes after pediatric intraocular lens implantation

PURPOSE: To report: refractive changes after cataract surgery and intraocul ar lens implantation in infants and children. METHODS: In an ongoing prospective study, the refractive errors of all pati ents younger than 18 years undergoing intraocular lens implantation were de termined at: 6 weeks, 3 months, 6 months, and 1 year, and at least: yearly thereafter. All patients with greater than 6 months of follow-up were inclu ded in the study, RESULTS: Eighty-three eyes of 81 patients were identified. Cataracts were t raumatic in 32 eyes (38%) and developmental in 42 eyes (50%). At implantati on, the mean (+/-SD) age was 6.3 +/- 4.6 years (range, 9 months to 17 years ), The mean follow-up was 26,6 months (range, 6 months to 6.6 years),Patien ts 0 to 2 years old at the time of implantation demonstrated a mean myopic shift of -3.00 diopters during a mean follow-up period of 2,5 years. Patien ts 2 to 6 years old at the time of implantation demonstrated a mean myopic shift of -1.50 diopters in a similar follow up period. Children aged 6 to 8 years experienced a mean myopic shift of -1.80 diopters during a mean foll ow-up period of 3.0 years, while children older than 8 years at the time of intraocular lens implantation experienced a mean myopic shift of -0,38 dio pters during a mean follow-up period of 1.8 years. On average, the operated -on eye showed a greater mean myopic shift: than the fellow eye. No statist ically significant differences in refractive change were found in comparing amblyopic to nonamblyopic eyes, traumatic to nontraumatic cataracts, or pr imary to secondary intraocular lenses. CONCLUSIONS: Our data demonstrate a trend reward increasing postoperative m yopia in pediatric patients undergoing intraocular lens implantation. This myopic shift is greatest in the younger age groups and persists until at: l east 8 years of age. There is much variability in the postoperative refract ive changes, and predicting exactly when and where the refraction will stab ilize for an individual patient is difficult. (Am J Ophthalmol 1998;126:772 -781. (C) 1998 by Elsevier Science Inc. All rights reserved,).