Long-term observation of myopic shift after secondary intraocular lens implantation in children with congenital cataract and its association with preoperative ocular parameters.

PURPOSE: This study aimed to investigate myopic shift (MS) after secondary intraocular lens (IOL) implantation in children with congenital cataract (CC) and its association with preoperative ocular parameters.

METHODS

This single-center retrospective study enrolled CC children who underwent primary lensectomy with anterior vitrectomy at 2-12 months and secondary IOL implantation at 24-42 months, with regular follow-up for at least 5 years. Patients were divided into unilateral and bilateral CC groups. In unilateral CC group, affected eyes were defined as the treatment group and contralateral healthy eyes as the fellow-eye group. Preoperative ocular parameters and postoperative outcomes were recorded. Linear regression was used to analyze factors associated with postoperative MS.

RESULTS

A total of 129 CC children (258 eyes) were included. In unilateral treatment group, MS was significantly greater than in fellow eyes (all P < 0.001). Larger interocular axial length difference (IALD) and higher cylindrical power were associated with greater MS (P = 0.019 and P < 0.001, respectively). In bilateral CC, MS was significantly higher at 1-3 years postoperatively (P < 0.05), but not at 4-5 years or final follow-up (P > 0.05). Shorter preoperative AL and higher cylindrical power were associated with greater MS (P = 0.006 and P < 0.001, respectively). No significant postoperative cylindrical power changes were observed in either group (P > 0.05).

CONCLUSIONS

Postoperative MS was greater in treated eyes of unilateral CC children than in fellow eyes and bilateral CC eyes. Preoperative evaluation of IALD in unilateral CC, AL in bilateral CC, and corneal astigmatism in all CC children may help optimize target refraction and long-term refractive outcomes.