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  • Both age and keratometry affect outcomes after pediatric cataract surgery

    Pediatric Ophth/Strabismus

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    Review of: Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: Implications for postoperative target refraction and IOL power selection

    VanderVeen D, Oke I, Nihalani B. American Journal of Ophthalmology, July 2022

    This prospective longitudinal study of biometry data assessed changes in refraction and axial length in children following cataract surgery to determine risk factors for greater myopic shifts.

    Study design

    Data were collected for 110 children <10 years of age who underwent cataract surgery with IOL placement (162 eyes) and 100 normal controls (100 eyes). Included study participants had ≥5 years of follow-up and at least 5 follow-up visits. The main outcomes were myopic shift and rate of refractive growth.

    Outcomes

    Younger age (0–4 years) was most strongly associated with a greater myopic shift; other risk factors included male sex and lower keratometry (flatter Ks). Lower keratometry was also associated with a higher rate of refractive growth.

    Limitations

    The most significant study limitation was the relatively few numbers of patients in the youngest and oldest age groups who underwent cataract surgery.

    Clinical significance

    IOL power selection in children is challenging due to the difficulty in predicting changes in axial length and keratometry. While younger age has consistently been shown to be the most significant predictor of myopic shift, the authors provide recommendations for target IOL refractions for pediatric cataracts that take into account both age and keratometry at time of cataract surgery.