Accuracy of Intraocular Lens Power Calculation in Pediatric Secondary Implantation: In-the-Bag Versus Sulcus Placement

center dot PURPOSE: To compare the effects of secondary in-the- bag vs ciliary sulcus intraocular lens (IOL) implantation on the accuracy of IOL power calculation in pediatric eyes.center dot DESIGN: Prospective nonrandomized interventional study.center dot METHODS: Pediatric aphakic eyes that underwent ei- ther in-the-bag or ciliary sulcus secondary IOL implan- tation were included. The mean prediction error (PE), mean absolute error (MAE), median absolute error, and percentages of eyes with PE within +/- 0.25 diopter (D), +/- 0.50 D, +/- 0.75 D, and +/- 1.00 D were calculated and compared using SRK/T formula.center dot RESULTS: One hundred fourteen eyes (38.26%) re- ceived in-the-bag IOL implantation and 184 (61.74%) underwent ciliary sulcus IOL implantation. Compared with the sulcus group, the capsular group displayed signif- icantly lower MAE and higher percentage of eyes within +/- 0.50 D of PE (MAE: 0.90 vs 1.56 D; +/- 0.50 D: 40.40% vs 14.29%, both P <.001). The eyes receiv- ing in-the-bag IOL implantation (sulcus IOL implanta- tion fi: -1.060, 95% CI:-1.415 to-0.705; P <.001), unilateral ( fi: 0.647, 95% CI: 0.144-1.150; P=.012), or with deeper anterior chamber depth ( fi: 0.362, 95% CI: 0.068-0.656; P=.016) were prone to maintain hy- peropia (PE > 0). To reduce PE, when the predicted cap- sular IOL power was between 11.50 and 30.00 D, the power of a sulcus-implanted IOL should be reduced by 0.50 to 2.50 D accordingly (the exact amount of reduc- tion is positively related to the predicted power).center dot CONCLUSIONS: In-the-bag implantation yielded smaller PE in pediatric eyes undergoing secondary IOL implan- tation. Adjustment of IOL power for ciliary sulcus im- plantation is required to reduce PE, and the amount of adjustment is positively correlated with the IOL power predicted by SRK/T formula. (Am J Ophthal- mol 2023;249: 137-143.(c) 2022 Elsevier Inc. All rights reserved.)