Validation of Guidelines for Undercorrection of Intraocular Lens Power in Children.
OBJECTIVE
Initial undercorrection of intraocular lens (IOL power) is a common practice in children undergoing pediatric cataract surgery. However, the long-term refractive status of these children is largely unknown. The purpose of this study is to analyze the long-term refractive status of these children.


METHODS
Retrospective observational study.


METHODS
We analyzed records of children (<7 years of age) who underwent cataract surgery with a primary IOL implantation and had completed follow-up to ≥7 years of age. Data were collected regarding demographics, etiology of cataract, method of undercorrection, and serial follow-up refractions. Prediction error was defined as refractive error minus emmetropia. The main outcome measure was prediction error at 7 years of age.


RESULTS
Eighty-four eyes of 56 children (28 unilateral and 28 bilateral cases) met the study criteria. The median age at surgery was 3.3 years (interquartile range 2.7-5 years), and the median follow-up period was 3.75 years. At 7 years of age, the median absolute prediction was 1.5 diopters (interquartile range 0.75-2 diopters). Seven of 84 (8.3%) children achieved emmetropia while an equal proportion were myopic (45%) or hypermetropic (46%). Prediction error (adjusted for using both eyes) at 7 years of age was not significantly different in any group (P > .05). Maximum myopic shift was observed in children <2 years of age. Age at surgery was the only significant factor that influenced prediction error (â = -0.32; P = .001).


CONCLUSIONS
This study suggests that children undercorrected using guidelines suggested by Enyedi and associates may achieve an acceptable refractive error at 7 years of age. However, in children <2 years of age, more hypermetropia may be observed. More studies are needed to validate various methods of undercorrection and compare with other guidelines.
Nimmagada Prasad Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India. Electronic address: vsachdeva@lvpei.org.
Virender
V
Sachdeva
Jasti V. Ramanamma Children Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India.
Sushma
S
Katukuri
Jasti V. Ramanamma Children Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India; Child Sight Institute and Jasti V. Ramanamma Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India.
Ramesh
R
Kekunnaya
Nimmagada Prasad Children's Eye Care Centre, Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, L.V. Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India.
Merle
M
Fernandes
Centre for Clinical Epidemiology and Biostatistics, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India.
Mohammed Hasnat
MH
Ali
D000293:Adolescent; D002386:Cataract / Q000150:complications*; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007910:Lenses, Intraocular / Q000592:standards*; D008297:Male; D009216:Myopia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D017410:Practice Guidelines as Topic; D019591:Pseudophakia / Q000503:physiopathology*; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology