High Myopia after IOL Implantation in Children

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High Myopia after IOL Implantation in Children

• Rupal H. Trivedi, MD MSCR
• M. Edward Wilson, MD
• Susannah Mistr, MD
• Storm Eye Institute
• Medical University of South Carolina

The authors have no financial interest
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Background

• Myopic shift after cataract surgery in children
  is known to occur frequently.
• Many physicians select an IOL power that will
  provide hypermetropia during the early
  postoperative period. Thus, myopia can be
  minimized even after myopic shift.
• However, as very high initial hypermetropia is
  amblyogenic, many physicians choose moderate
  hypermetropia.
• Myopic shift in these eyes with moderate
  hypermetropia eventually may eventually cause
  high myopia to develop in some children.

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Myopic shift of refraction after cataract surgery
in children Why?
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Expected immediate postoperative refraction at
the time of cataract surgery
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Residual refraction in our series
We do not recommend the use of any published
table alone for deciding IOL power. These tables
are only meant to help as a starting point toward
appropriate IOL power selection, which is a
multifactorial decision customized for each child
based on many variables especially, age,
laterality (one eye or both), amblyopia status
(dense or mild), likely compliance with glasses,
and family history of myopia.
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Purpose

• To explore eyes with high myopia after
  cataract-IOL surgery in children

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Method

• IRB approved retrospective database review
• Study population eyes with primary IOL
  implantation in children
• Exclusion criteria polypseudophakia, Non
  availability of postoperative spherical
  equivalent, follow-up lt 1 year
• High myopia is defined as spherical equivalent
  -5 D

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-5 D Postoperative Spherical Equivalent

• 9.1 (25/276)
• 19.5 (17/87) with more than 5 years of follow-up
  vs 4.2 (8/189) with lt 5 years of follow-up

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-5 D Postoperative Spherical Equivalent

• 10.5 of females and 7.9 of males (Female
  13/124 Male 12/152)
• 9.4 of Caucasians and 9.7 of African-Americans
  (Cauc 18/191 Af-Am 7/72)
• 15.2 of unilateral and 5.3 of bilateral cases
  (Unilateral 16/105 Bilateral 9/171).

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-5 D Postoperative Spherical Equivalent
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Results

• One child require surgical intervention because
  of high myopia
• 8/25 eyes had associated postoperative glaucoma
• Other possible causes?
• - hereditary
• - error in preoperative axial length
  measurement
• - error in IOL power calculation formulas for
  shorter eyes

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Summary

• Despite moderate undercorrection at the time of
  surgery, high myopia occurs occasionally in
  pseudophakic eyes of children
• As expected, with a longer follow-up, prevalence
  of myopia is increasing
• Preoperative counseling of the parents should
  include possible future treatments such as
  refractive surgery or IOL exchange.