Myopic shift after primary intraocular lens implantation in unilateral cataract children and its association with preoperative ocular parameters

Purpose: To assess the myopic shift in children with unilateral cataract undergoing primary intraocular lens (IOL) implantation and its association with preoperative ocular parameters.

Setting: Single center.

Design: Retrospective study.

Methods: Children who underwent unilateral primary IOL implantation and were followed up for 3 years were included. Myopic shift and preoperative ocular parameters were compared between the treated and fellow eyes. The correlation between myopic shift and ocular parameters was assessed using partial correlation analysis. Potential factors influencing myopic shift were determined using linear regression analysis.

Results: A total of 126 patients (252 eyes) were included. Longer preoperative axial length (AL) and steeper average keratometry (AK) in the treated eyes were noted in the whole cohort and patients aged 2 to <4 years (all P < .05). At 3 years postoperatively, mean myopic shift ranged from 3.53 diopters for children aged 1 to <2 years to 1.99 diopters for those aged 6 years and older. A greater myopic shift in the treated eyes was found in all, except children aged 6 years and older ( P > .05). Preoperative interocular AL difference (IALD) was negatively correlated with myopic shift ( r = 0.32, P < .001). Regression analysis revealed that younger age and smaller IALD were associated with greater myopic shift ( P < .001 and P = .001, respectively).

Conclusions: A greater myopic shift was observed in children with younger age at surgery and smaller IALD. To mitigate long-term anisometropia, selecting target refraction for unilateral pediatric cataracts should consider children's age, refractions of the fellow eyes, and preoperative IALD.