refractive shift in pediatric pseudophakia over a 10- years follow-up

purpose: to report the refractive changes after intraocular lens (iol) implantation in children with congenital and developmental cataract. methods: in this historical cohort study, the clinical records of children between 2 and 15 years old that had lensectomy with posterior capsulotomy, anterior vitrectomy and iol implantation with more than 5 years of follow-up were studied. refractive errors were measured at 1 and 3 months postoperatively and every 6 months onwards. patients were stratified according to age at the time of surgery: group 1 (2-<4 years old), group 2 (4-<7 years old) and group 3 (7-15 years old). groups were compared in terms of myopic shift and the rate of changes toward myopia. additionally, the influence of age at the time of surgery, iol power and best-corrected visual acuity on myopic shift and the progression rate were assessed. an estimation for undercorrection of iol power was provided on the basis of the refractive error at the final follow-up examination. results: forty-one pseudophakic eyes of 22 children were enrolled. the mean myopic shift was -4.93 diopters in group 1, -2.99 diopters in group 2 and -0.44 diopters in group 3. the rate of refractive change was -0.53 diopter per year, -0.39 diopter per year and -0.12 diopter per year, respectively. total amount and rate of myopic shift was significantly higher in younger children (less than 7 years old). the variability in refractive change, measured by standard deviation, decreased from 2.84 diopter in group 1 to 1.72 in group 2 to 1.69 in group 3. in contrast to age, myopic shift had no correlation with iol power, postoperative refraction and bestcorrected visual acuity. an undercorrection of 20% and 15% in iol power for 2-4 and 4-7 year-old patients, respectively, would have decreased the odds of high myopic refraction at older ages. conclusion: age at the time of surgery had a significant association with myopic shift in pediatric patients who underwent congenital cataract surgery with primary iol implantation. the rate of myopic shift was also greater in younger children. although undercorrection of iol power by 20% and 15% in 2-4 and 4-7 year-old patients, respectively, could decrease the refractive error at the older age, this adjustment might be associated with hyperopia due to variability in the rate of myopic progression.