Validation of Guidelines for Undercorrection of Intraocular Lens Power in Children

Sachdeva, Virender; Katukuri, Sushma; Kekunnaya, Ramesh; Fernandes, Merle; Ali, Mohammed

doi:10.1016/j.ajo.2016.10.017

Cited by 27 publications

(26 citation statements)

References 23 publications

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“…One possible explanation is that there are difficulties in the measurement of ocular parameters (axial length, keratometry) in young children and this may lead to more errors in the IOL power calculation. However, our findings are in contrast to those of Sachdeva et al, 10 who found more hypermetropia in children aged less than 2 years and suggested that less undercorrection was required in this age group. It was concluded that more data are needed to confirm the trends in refractive errors in this age group.…”

Section: Discussioncontrasting

confidence: 99%

Long-term outcomes of intended undercorrection intraocular lens implantation in pediatric cataract

Lekskul¹,

Chuephanich²,

Charoenkijkajorn³

2018

OPTH

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PurposeTo evaluate the postoperative refraction of intended undercorrection after intraocular lens (IOL) implantation in pediatric cataract patients.DesignA cross-sectional study (data collected by retrospective chart review).Patients and methodsThe medical records of children aged under 10 years, who underwent cataract surgery with IOL implantation at the Ramathibodi Hospital between January 2000 and May 2018, were reviewed. IOL power calculations were 30%, 25%, 20%, 15% and 10% under-corrected if children were aged 6–12, 13–24, 25–36, 37–48 and 49–60 months, respectively. Two diopters (D) undercorrection was used in children aged between 5 and 8 years and one diopter undercorrection was used in children aged between 8 and 10 years. The main outcome measure was the postoperative refractive errors at the last follow-up visit.ResultsIn total, 50 children (21 females and 29 males, 16 unilateral and 34 bilateral, 84 eyes) met the inclusion criteria for this study. Mean age at the time of surgery was 77.82±31.24 months. Mean follow-up time was 56.56±45.83 months. The main outcome in this study was the postoperative refractive error in children aged 7 years or more. We found 74 eyes of 44 children who were aged 7 years or more at last follow-up visit. In total, 45 eyes were myopic (−0.25 to −8.25 D) with a mean refraction of −2.26±2.16 D. A further 21 eyes were hyperopic (+0.25 to +3.25 D), with a mean refraction of +1.05±0.79 D and eight eyes were emmetropic or having only astigmatism.ConclusionThe major postoperative refractive error at the last follow-up time was myopia. We have to adjust the IOL calculation formula to specify more undercorrection, with the aim of achieving more optimal refractive outcomes in adulthood.

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Section: Discussioncontrasting

confidence: 99%

Long-term outcomes of intended undercorrection intraocular lens implantation in pediatric cataract

Lekskul¹,

Chuephanich²,

Charoenkijkajorn³

2018

OPTH

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“…[14] This rule was validated by Sachdeva et al . [15] McClatchey and Parks calculated the theoretic long-term refractive effects of pseudophakia in a large group of aphakic eyes with long-term follow-up and predicted a 6.6 D mean myopic shift (range, 36.3–2.9) over a mean follow-up of 11 years. Children aged 2 years and under at the time of surgery had a significantly greater predicted myopic shift and a greater variance in the predicted refractive change than those >2 years at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

Biometric changes in Indian pediatric cataract and postoperative refractive status

Khokhar

Tomar

Pillay

et al. 2019

Indian J Ophthalmol

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Purpose: To prospectively evaluate the biometric changes in Indian pediatric cataract and postoperative refractive status. Methods: A total of 147 patients were recruited into three groups: age <6 months, age between 7 months and 18 months, and age between 19 and 60 months and prospectively observed for 6 months. Exclusion criteria were preterm birth, microphthalmia, microcornea, megalocornea, uveitis, glaucoma, and traumatic or complicated cataract. Axial length and keratometry, the primary outcome measures, were taken preoperatively under general anesthesia before surgery. These children were followed up for 6 months to look for refractive and biometric changes. T-test and linear regression with the logarithm of independent variables were done. Results: All unilateral cataractous eyes ( n = 25) and randomly selected bilateral cases ( n = 122) were included in the analysis, for a total of 147 eyes. Mean age was 17.163 ± 13.024 months; axial length growth was 0.21, 0.18, 0.06 mm/month, and keratometry decline was 0.083, 0.035, 0.001 D/month in age groups 0–6, 7–18, and 19–60 months, respectively. The visual acuity improved in log MAR from 1.020 to 0.745 at 6 months postoperatively. There was statistically significant (Spearman's correlation coefficient = –0.575, P < 0.001) between age and postoperative refraction. There were no intraocular lens (IOL)-related complications seen in the immediate postoperative period. Peripheral opacification was seen in 102 eyes and central opacification in 1 eye at a 6-month follow-up. Conclusion: Indian eyes have a lower rate of axial length growth and keratometry change in comparison with western eyes implying smaller undercorrection in emmetropic IOL power for Indian pediatric eyes to achieve a moderate amount of hyperopia.

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“…In general, Enyedi's rule of seven is followed which is validated. [34] The suggested under correction formulae 20% for <2 years and 10% for 2–8 years[35] does not corroborate with the axial length growth and the target refraction required for age. Hence, there is a need to develop a new under correction formulae for children.…”

Section: Intraocular Lens Power Calculationmentioning

confidence: 99%

Innovations in pediatric cataract surgery

Khokhar

Pillay

Agarwal

et al. 2017

Indian J Ophthalmol

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Advances in technology have made surgery in children safer and faster. The management of pediatric cataract has made rapid progress in the past decade with the availability of safer anesthesia, newer technique's, more predictable intraocular lens (IOL) power calculation, a better understanding of neurobiology, genetics, amblyopia management, improved IOL designs for preventing visual axis opacification, and adjuvant postoperative care. Modern vitrectomy machines with minimally invasive instruments, radiofrequency, diathermy, and plasma blades help immensely in complicated cases. Preoperative evaluation with ultrasound biomicroscopy and optical coherence tomography (OCT) allows better planning of surgical procedure. The future holds good for stem cell research, customized OCT, and Zepto (precision pulse capsulotomy).

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Validation of Guidelines for Undercorrection of Intraocular Lens Power in Children

Cited by 27 publications

References 23 publications

Long-term outcomes of intended undercorrection intraocular lens implantation in pediatric cataract

Long-term outcomes of intended undercorrection intraocular lens implantation in pediatric cataract

Biometric changes in Indian pediatric cataract and postoperative refractive status

Innovations in pediatric cataract surgery

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