Accuracy of biometry in pediatric cataract extraction with primary intraocular lens implantation

Abstract

Data from 203 consecutive primary pediatric IOL implantations showed the heterogeneous nature of the variables involved in predictions of refractive outcomes in this population. The complexities of this issue support the need for specific methods of measurement and an IOL calculation formula for the pediatric population.

Refractive outcomes with secondary intraocular lens implantation in children

“…An earlier pediatric secondary IOL study by Awad and colleagues 9 found that 78% of patients had a postoperative refraction AE2 D of the predicted value, although the authors acknowledged the data represented cases from numerous surgeons, each with individualized refractive goals. The data available from publications of primary IOL implantation in pediatric patients show similar variability, ranging from 1.06 AE 0.79 D to 1.79 AE 1.47 D. 5,6 There are several explanations for the error in predicted refractive outcome. Holladay 10 has reported the effects of axial displacement if the effective lens position of stronger lenses is not exact.…”

“…[2][3][4][5] Recent studies have demonstrated the inaccuracy of postoperative predicted refractive outcomes in pediatric patients undergoing primary IOL implantation; however, the accuracy of secondary IOL implantation in pediatric eyes remains largely unknown. 5,6 As such, this study was designed to determine the accuracy of the actual postoperative refractive outcome with secondary IOL implantation in aphakic children. Associations between refractive accuracy and other variables historically considered important in cataract surgery were tested to determine if any showed significant correlation.…”

Reanalysis of refractive growth in pediatric pseudophakia and aphakia

“…2,7,8 Several studies have been conducted to test their validity when applied to children. The mean absolute error in many of these studies ranged from 1.06 D to 1.4 D, 11,[18][19][20][21] which was greater than the mean absolute error of 0.5 D to 0.7 D found in adults. 22,23 In more recent studies, authors have found mean absolute prediction errors of 0.76 to 1.18 when they applied the adult IOL formulas to pediatric patients, 24,25 still with only 43% of eyes with less than 0.5 D of error.…”

Pediatric Intraocular Lens Implantation: Historic Perspective and Current Practices

“…As children grow, the axial length, corneal curvature, and lens growth all help maintain emmetropia. 42 Axial length increases rapidly until age 2 and the corneal curvature decreases for the first 6 months of life. 18 Cataract extraction with implantation of an IOL may slow down the axial growth of the eye, but not all studies have supported this and it is highly variable from patient to patient.…”

“…Owing to the changes in the biometry of the pediatric eye, a dramatic myopic shift occurs up to about age 2 years and continues at a slower rate until about 8 years. 42,44 Over this timeframe, most children undergo about 6 diopters of myopic shift. 44 Because of this, the desired result for most cataract surgeons is hyperopic to account for the expected shift, although the results of Wilson's survey of ASCRS and AAPOS members in 2003 show a large variation in the postoperative refractive goals after IOL implantation in young children.…”