Choosing IOL Power in Pediatric Cataract Surgery

McClatchey, Scott K.

doi:10.1097/iio.0b013e3181f0f2e0

Cited by 20 publications

(15 citation statements)

References 25 publications

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“…However, given that the sample size of the study was not based upon assessing these associations, the results should not be considered definitive. McClatchey and co-authors have extensively modeled refractive changes in both aphakic and pseudophakic eyes in several publications 15,21 the most recent model 22 the Rate of Refractive Growth 3 (RRG3), which corrects for both intrauterine eye growth and refraction at the spectacle plane describes a logarithmic rate of refractive growth with the most rapid myopic change in early infancy. In this study we also found a significantly higher rate of refractive change at younger ages using a linear spline model to fit the non-linear data.…”

Section: Discussionmentioning

confidence: 99%

Myopic Shift 5 Years after Intraocular Lens Implantation in the Infant Aphakia Treatment Study

et al. 2017

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Purpose To report the myopic shift at 5 years of age after cataract surgery with IOL implantation for infants enrolled in the Infant Aphakia Treatment Study. Methods Refractions were performed at 1 month and every 3 months postoperatively until age 4 and then at ages 4.25, 4.5 and 5 years. The change in refraction over time was estimated by linear mixed model analysis. Results IOL implantation was completed in 56 eyes; 43 were analyzed (median age = 2.4 mo, range = 1.0 – 6.8 mo). Exclusions included 11 patients with glaucoma, one patient with Stickler syndrome and one patient with an IOL exchange at 8 months postoperatively. The mean rate of change in a myopic direction from 1 month after cataract surgery up until age 1.5 years was 0.35 D/mo (95% CI = 0.29,0.40 D/mo); after age 1.5 years the mean rate of change in a myopic direction was 0.97 D/yr (95% CI = 0.66, 1.28 D/yr). The mean refractive change at age 5 years for children 1 month of age at surgery was 8.97 D (95% CI, 7.25, 10.68 D) and for children 6 months of age at surgery was 7.22 D (95% CI, 5.54, 8.91 D). The mean refractive error at age 5 years was −2.53 D (95% CI, −4.05, −1.02) Conclusion After IOL implantation during infancy, the rate of myopic shift occurs most rapidly during the first one and one-half years of life. Myopic shift varies significantly amongst patients. If the goal is emmetropia at age 5 years, then the immediate postoperative hypermetropic targets should be +10.5D at 4 to 6 weeks and 8.50 D from 7 weeks to 6 months. However, even using these targets it is likely that many children with require additional refractive correction given the high variability of refractive outcomes.

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Section: Discussionmentioning

confidence: 99%

Myopic Shift 5 Years after Intraocular Lens Implantation in the Infant Aphakia Treatment Study

et al. 2017

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“…First, our immediate postoperative refractive targets of +8D or +6D targets, which were based on an expected myopic shift derived from analysis of previous studies, 20–27 were not large enough to compensate for the actual myopic shift observed in many of these patients. Furthermore, greater myopic shift in the treated eye was highly correlated with greater anisometropia at the age 5 years visit.…”

Section: Discussionmentioning

confidence: 99%

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

Weakley

Cotsonis

Wilson

et al. 2017

American Journal of Ophthalmology

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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 +8D (infants 28 to <48 days of age) or +6D (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 (IQR, 1.2, 3.5 months). The mean age at the age 5 year follow-up visit was 5.0 ± 0.1 years (range, 4.9 – 5.4 years). The median refractive error at the age 5 year 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 +2.75D). 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=0.005) 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.

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“…Patients were rehabilitated using glasses or contact lenses in-between. For IOL power calculations, we followed published guidelines [20,21].…”

Section: Methodsmentioning

confidence: 99%

Factors Affecting Visual Outcome Following Surgical Treatment of Cataracts in Children

Shah¹,

Shah²,

Shikhangi³

et al. 2012

OJOph

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Purpose: To assess treatment results in pediatric patients with cataracts, to evaluate the efficacy of various surgical interventions, and to determine the factors that affect visual outcomes. Methods: This is aProspective cohort study. We studied a consecutive series of pediatric patients with congenital, developing, or traumatic cataracts who underwent surgery between January, 1999 and April, 2012 at Drashti Netralaya, Dahod. Patient demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. Results: In total, 1305 eyes of 1047 children were included: unilateral cataracts were present in 786 (60.2%) eyes. There were 610 (46.7%) traumatic and 695 (53.3%) non-traumatic cases. Ages at surgery ranged from 1 to 215 months. Eyes were grouped by the surgical intervention performed: Group 1, pars plana approach including 366 (28%) eyes that underwent lensectomies, and Group 2, anterior approach, including 939 (71.9%) eyes that underwent phacoemulsification ± IOL placement or small incision cataract surgery ±IOL placement. The mean follow-up time was 117 days. Ultimately, 113 (30.9%) Group 1 and 503 (53.6%) Group 2 patients achieved a visual acuity better than 20/60 (P < 0.001). Age at intervention, laterality, sensory nystagmus, pre-treatment vision, IOL insertion, and etiology were all significantly related (all P < 0.001) to visual outcome. Conclusions: Surgical treatment with intraocular lens implantation for children with congenital, developmental, or traumatic cataracts is an effective treatment for visual rehabilitation. Visual outcome was significantly better in cases of traumatic cataracts versus non-traumatic cataracts.

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Choosing IOL Power in Pediatric Cataract Surgery

Cited by 20 publications

References 25 publications

Myopic Shift 5 Years after Intraocular Lens Implantation in the Infant Aphakia Treatment Study

Myopic Shift 5 Years after Intraocular Lens Implantation in the Infant Aphakia Treatment Study

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

Factors Affecting Visual Outcome Following Surgical Treatment of Cataracts in Children

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