Refractive Change at 5 Years in the Toddler Aphakia and Pseudophakia Study.

PURPOSE: To report refractive change at 5 years of age in children with pseudophakic eyes operated on before 2 years of age.

DESIGN

Retrospective case series at 10 Infant Aphakia Treatment Study (IATS) sites.

PARTICIPANTS

Children who underwent cataract surgery with primary intraocular lens (IOL) placement during the IATS enrollment years, including infants 1 to younger than 7 months of age with bilateral cataract and all children 7 to 24 months of age, regardless of laterality.

METHODS

Change in spherical equivalent refractive error (in diopters [D]) was calculated from 1 month after surgery to 5 years of age and was compared for patients with unilateral and bilateral (first eye only) cataract and for children 1 to < 7 months versus 7-24 months of age at surgery.

MAIN OUTCOME MEASURES: Refractive change (D) from surgery to 5 years of age.

RESULTS

Ninety-six children were included: 50 children with unilateral cataract (surgery at age 7-24 months) and 46 children with bilateral cataract (n = 20 with surgery at age 1 to < 7 months; n = 26 with surgery at age 7-24 months). Median refractive change was significantly greater for eyes in the bilateral group undergoing surgery at age 1 to < 7 months (7.50 D; range, 2.5 to 15 D) versus age 7 to 24 months (1.94 D; range, -1.88 to 7.75 D; P < 0.001). For children 7-24 months of age at surgery, median change was similar between those with unilateral cataract (3.25 D; range, -1.75 to 13.5 D) versus bilateral cataract (1.94 D; range, -1.88 to 7.75 D; P = 0.053). By 5 years of age, no eyes in the 1 to < 7 month age group had less than 2.5 D myopic shift, but in the 7-24 month age group, 62% of patients with bilateral cataract and 38% of patients with unilateral cataract showed less than 2.5 D myopic shift.

CONCLUSIONS

Greater magnitude and variability in refractive change was found in pseudophakic eyes undergoing surgery at 1 to < 7 months of age and for patients with unilateral cataract, which should be considered when choosing IOL power and initial postoperative target refraction for infants and toddlers.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.