Myopic Shift over 5 Years after Pediatric Lensectomy with Primary Intraocular Lens Implantation

Purpose: To report the change in refractive error over 5 years after primary intraocular lens (IOL) placement by age at surgery and to identify factors associated with the change in refractive error after 5 years. Design: Prospective observational study at 61 pediatric eye care practices. Participants: One hundred eighty-six eyes of 152 children undergoing primary IOL implantation before 13 years of age for nontraumatic cataract. Interventions: Cataract surgery with primary IOL placement. Main Outcome Measures: Five-year change in refractive error (spherical equivalent) by age at surgery and by immediate postoperative myopia versus emmetropia or hyperopia. Results: Mean spherical equivalent myopic shift was -5.99 diopters (D; 95% confidence interval [CI], -7.64 to -4.34 D) when surgery was performed at 0 to younger than 1 year of age (n = 13), -3.53 D (-4.57 to -2.48 D) at 1 to younger than 2.5 years of age (n = 28), -1.91 D (-2.55 to -1.26 D) at 2.5 to younger than 4 years of age (n = 36), -2.04 D -2.60 to -1.49 D) at 4 to younger than 7 years of age (n = 60), and -0.83 D (-1.27 to -0.40 D) at 7 to younger than 13 years of age (n = 49; P < 0.01 for each comparison with the oldest group). Variability of myopic shift also decreased with increasing age (P < 0.01). In eyes of children 4 to younger than 13 years of age (small sample size precluded analysis of children younger than 4 years), significantly less mean change in refractive error was found over 5 years in eyes with myopia immediately after surgery (-0.69 D; 95% CI, -1.48 to 0.10 D; n = 27) than eyes with emmetropia or hyperopia immediately after surgery (-1.70 D; 95% CI, -2.10 to -1.31 D, n = 82; difference, -1.01 D [95% CI, -1.89 to -0.14 D]; P = 0.03). Conclusions: In this large, prospective cohort study of children younger than 13 years undergoing cataract surgery with primary IOL placement, greater and more variable myopic shift was found in children undergoing surgery at a younger age. Our finding of less myopic shift over 5 years in eyes with unintended immediate postoperative myopia deserves further study to guide IOL power selection more accurately. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. Ophthalmology 2025;132:290-298 (c) 2024 by the American Academy of Ophthalmology