Theoretic Refractive Changes after Lens Implantation in Childhood

Advances in the management of congenital and infantile cataract

“…33 There is little published data on long-term refractive shift following IOL implantation in infants. In aphakic eyes, the mean quantity of myopic shift from age 3 months to 20 years has been shown to be 9.7 D. 30 In our personal series of 25 infants (33 eyes) implanted before 12 months of age, it was found that the mean myopic shift at 12 months was 4.83 D. This increased to 5.3 D in those infants implanted before 10 weeks of age. 34 The initial desired refractive outcome following IOL implantation is therefore hypermetropia, with the degree depending on age of the child.…”

“…The resulting rate of refractive growth follows a logarithmic curve. 30 Achieving a satisfactory long-term refractive result following IOL implantation in infancy and childhood requires that an allowance be made for the axial growth and myopic shift that occurs during childhood. The rate of axial growth following cataract surgery is fastest at younger ages, particularly during the first year of life.…”

How should blindness in children be managed?

“…The obvious disadvantage of IOLs especially in very young children is that their eye is still growing and its refraction changingFwhat power of lens should be inserted? Most surgeons advocate mild undercorrection to allow for the predicted myopic shift (likely to be higher in a pseudophakic than a phakic growing eye because compensatory emmetropizing changes in lens shape cannot occur 6 ). Others argue that since amblyopia is the limiting factor in visual outcome for most of these patients, emmetropia (or even myopia since an infant's visual environment is largely at near in reach of his or her hands) during the amblyogenic period is more important than emmetropia in later life and they Data from published studies, which included 1683 children.…”

Predictability of Intraocular Lens Calculation Using the Holladay II Formula after in-the-Bag or Optic Captured Posterior Chamber Intraocular Lens Implantation in Paediatric Cataracts

“…Previous retrospective studies have shown the myopic shift as well as the error range in IOL power calculation in children [7, 8,11,12,13,14,15,16,17,18]. To reduce the necessity of IOL exchange, these eyes may be undercorrected, with the residual refractive error corrected by spectacles that are adjusted throughout life according to the refractive development.…”