Aim-To assess changes in axial length, corneal curvature, and refraction in paediatric pseudophakia. Methods-35 eyes of 24 patients with congenital or developmental lens opacities underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation. Serial measurements were made of axial length, corneal curvature, objective refraction, and visual acuity. Results-For patients with congenital cataracts (onset <1 year age) the mean age at surgery was 24 weeks. Over the mean follow up period of 2.7 years, the mean increase in axial length of 3.41 mm was not significantly diVerent from the value of an expected mean growth of 3.44 mm (paired t test, p=0.97) after correction for gestational age. In the developmental cataract group (onset >1 year of age) the mean age at surgery was 6. Conclusion-The pattern of axial elongation and corneal flattening was similar in the congenital and developmental groups to that observed in normal eyes. No significant retardation or acceleration of axial growth was found in the eyes implanted with IOLs compared with normal eyes. A myopic shift was seen particularly in eyes operated on at 4-8 weeks of age and it is recommended that these eyes are made 6 D hypermetropic initially with the residual refractive error being corrected with spectacles. (Br J Ophthalmol 1999;83:265-269) Among the problems which arise regarding the use of intraocular lenses (IOLs) in the paediatric population is the question of the power of the implant that should be used, considering the expected growth of the child's eye. The majority of eye growth takes place in the first 18 months of life after which there is little change.

With careful management and patient selection, the use of IOLs in children can produce good visual results with a minimum of complications. Further follow-up is needed to assess the long-term visual outcome, complications, and changes in refraction.

Conclusions-In the diode laser group there were significantly fewer myopes than in the cryotherapy group up to 3 years after the procedure. There was no trend towards increasing myopia in the laser treated group and the refraction in these eyes stabilised after 1 year. In the cryotherapy group there was a significant increase in the degree of myopia between year 1 and year 3 of follow up (p=0.02). Diode laser treatment is thought to be as effective as cryotherapy, and has the added benefit of reducing myopia, in the treatment of ROP.

Although the multicentre trial of cryotherapy for retinopathy of prematurity showed that treatment of threshold disease (stage 3 acute ROP in zones 1 or 2, for eight cumulative or five contiguous clock hours, with plus disease) with cryotherapy results in a 50% decrease in unfavourable outcomes, a significant number of cases progress from threshold disease to stages 4 and 5 -that is, partial or total retinal detachment.' A previous study by Robinson and O'Keefe found an incidence of poor visual outcome (vision <6/60) in 56% of eyes reaching stage 3 disease and an incidence of total retinal detachment of 6 5%.2 This study examines the incidence of complications and the structural and visual outcomes of infants with grade 4 and 5 cicatricial retinopathy of prematurity. ResultsThirty one eyes of 17 patients were included in the study. The mean gestation of the patients was 26-77 (range 24 to 30) weeks and the mean birth weight was 951-43 (range 600 to 1500) g. The mean postnatal age at the first eye examination was 12 (range 6 to 36) weeks or 39 weeks postmenstrual age (range 30 to 60) weeks (see Table 1). Transferred infants had a significantly lower mean gestational age than infants diagnosed in hospitals screened by the authors (p=0 04). The mean birth weight of transferred infants was also lower than that of the non-transferred infants but this was not statistically significant (p=0 6). The mean postnatal age at first eye examination was significantly greater in transferred versus nontransferred infants (p=0 009) and 80% (4/5) of the transferred infants were already stage 4 343 on 12 May 2018 by guest. Protected by copyright.