Postoperative longitudinal refractive changes in children younger than 8 years with ectopia lentis and Marfan syndrome

Abstract

Purpose: To evaluate the postoperative longitudinal refractive changes in children under 8 years of age with ectopia lentis and Marfan Syndrome (MFS). Setting: Zhongshan ophthalmic center, Guangzhou, China. Design: Retrospective cohort study. Methods: Medical data of patients diagnosed with ectopia lentis and MFS that underwent surgery before 8 years old were collected. Refractive errors and ocular biometric parameters were collected before surgery and at each follow-up visit. Patients were stratified into groups according to age at surgery and only the eye operated upon first was selected. Multivariable analysis was performed to determine the association between refractive shift and potential risk factors. Results: In total, 54 eyes of 54 patients were enrolled. The median age at surgery was 6.21 years (Interquartile range [IQR], 5.25 to 6.85) and the median follow-up was 2.0 years (IQR, 1.2 to 2.8 years). At 8 years old, patients demonstrated a median myopic shift ranged from -1.75 diopters (D) (IQR, -2.75 to -1.00 D) for the 4-year-old group to -0.13 D (IQR, -0.50 to -0.06 D) for the 7-year-old group. Multivariable analysis showed greater myopic shift was associated with younger age at surgery (P=0.004), male gender (P=0.026) and shorter preoperative axis length (P=0.005). Conclusion: A tendency toward increasing postoperative myopic was demonstrated in children with ectopia lentis and MFS, with the greatest myopic shift in the younger age groups. If the goal is to reach emmetropia by age 8, the immediate postoperative hypermetropic targets should be 1.75D for 4 years old, 1D for 5 years old, 0.5D for 6 years old, 0 to 0.25D for 7 years old.

Association Between Preoperative Ocular Parameters and Myopic Shift in Children Undergoing Primary Intraocular Lens Implantation

“…Various factors influencing axial growth in children after cataract surgery have been identified, including age at surgery, additional ocular surgery, postoperative glaucoma, and poor visual acuity. 26 – 30 Liu et al 13 reported that preoperative AL showed a negative correlation with axial elongation. Similarly, Trivedi and Wilson 15 observed that eyes with shorter AL than the fellow eyes exhibited a rate of axial growth exceeding that of the eyes with longer AL.…”

“…This finding aligns with the results reported by Zhou et al, 14 where they observed that children undergoing cataract surgery with longer ALs showed less myopic shift compared to those with shorter ALs. Liu et al 13 demonstrated that shorter AL was associated with greater myopic shift in children with Marfan syndrome who underwent cataract surgery. Valera Cornejo and Flores Boza 25 reported the myopic shifts in a cohort of 46 patients who received cataract surgery under 4 years of age.…”

“…Taking AL as an example, the range of preoperative AL of pediatric cataracts was large even in individuals of the same age. 11 Some reports revealed that a shorter AL was related to greater myopic shift, 13 – 15 and another study demonstrated that, rather than AL, a flatter cornea was associated with greater myopic shift. 16 …”