Comparison of IOL power calculation formulae for pediatric eyes

Refractive predictive errors using Barrett II, Hoffer-Q, and SRKT formulae for pediatric IOL implantation

PURPOSE

To compare the accuracy of the Barrett II universal (BU II) formula, Hoffer-Q, and SRKT formulae following lensectomy and IOL implantation in a large pediatric cohort.

METHODS

Retrospective study of children who underwent lensectomy and IOL implantation between 2015 and 2023 at Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

RESULTS

One hundred and fifty-one eyes of 104 children aged 6.0 ± 3.9 years were included. The mean prediction error (PE) was - 0.08 ± 1.54 diopters (D) with BU II, 0.24 ± 1.46 D with Hoffer-Q, and 0.71 ± 1.92 D with SRKT (P = 0.10). In eyes with axial length (AL) < 22 mm, BU II and Hoffer-Q had a smaller PE than SRKT (P = 0.024). In eyes with AL ≥ 22 mm, BU II had a smaller PE than Hoffer-Q (P = 0.048). In children 24 months or older at surgery, BU II had a smaller PE than SRKT and Hoffer-Q (P = 0.012). However, in younger children, no difference was found between the formulae (P = 0.61). For mean k-values ≥ 44.5 D, BU II and Hoffer-Q had a smaller PE than SRKT (P = 0.002). An absolute prediction error < 1.0 D was obtained with BU II in 66% of eyes and SRKT in 35% (P = 0.01).

CONCLUSIONS

The BU II formula performed well with a small prediction error. No significant difference in PE was detected overall between the formulae. However, only BU II demonstrated a stable prediction error at varying axial lengths, K-readings, and ages. As the biometric parameters of the developing eye change with growth, the BU II formula offers a reliable and stable option for pediatric IOL calculation.

A Bayesian network meta-analysis on comparisons of intraocular lens power calculation methods for paediatric cataract eyes

The study aimed to compare and rank the accuracy of formulas for calculating intraocular lens (IOL) power in paediatric eyes in a systematic way. A literature search was conducted in Pubmed, Web of Science, Cochrane Library, and EMBASE by December 2021. Combined with traditional and network meta-analysis, we analysed the percentages of paediatric eyes with prediction error (PE) within ±0.50 dioptres (D) and ±1.00 D as the outcome measurements among different formulas. Subgroup analyses stratified by age were also undertaken. Thirteen studies with 1781 eyes comparing 8 calculation formulas were included. For the traditional meta-analysis results, Sanders-Retzlaff-Kraff theoretical (SRK/T) (risk ratios (RR), 1.15; 95% confidence intervals (CI), 1.03-1.30) performed significantly better than the SRKII formula for the percentage of eyes with PE within ±0.50 D. In addition, SRK/T (RR, 1.10; 95% CI, 1.02-1.18) and Holladay 1(RR, 1.15; 95% CI, 1.01-1.30) both performed significantly better than the SRKII formula for the percentage of eyes with PE within ±1.00 D. Considering the ranking based on the surface under the cumulative ranking curve (SUCRA) by Bayesian method, the top four formulas were Barrett Universal II (UII), Haigis, Holladay 1, and SRK/T on the percentage of PE within ±0.50 D, whereas the top four formulas were Barrett UII, Holladay 1, SRK/T, and Hoffer Q formulas on the percentage of PE within ±1.00D. Concerning both outcome measurements of rank probabilities, the top three Barrett UII, SRK/T, and Holladay 1 formulas were considered to provide more accuracy for IOL power calculation in paediatric cataract eyes, and Barrett UII tends to perform better in older children.

Comparison of baseline biometry measures in eyes with pediatric cataract to age-matched controls

PURPOSE

To compare baseline biometry measurements in eyes with pediatric cataract versus age-matched controls METHODS: This is a cross-sectional study conducted at a tertiary care hospital that included two arms-prospective arm to collect data from normal eyes and retrospective arm for eyes with pediatric cataract. In the prospective arm, biometry measurements were obtained in healthy children aged 0 to 10 years. Children under the age of four had measurements under anesthesia for an unrelated procedure, while older children had in-office measurements using optical biometry. For comparison, biometric data was collected in children with pediatric cataract through record review. One eye of each patient was randomly selected. Axial length (AL) and keratometry (K) were compared by age and laterality. The medians were compared using Wilcoxon rank-sum tests and variances using Levene's test.

RESULTS

There were 100 eyes in each arm, 10 eyes in each age bin of 1-year interval. There was more variability in baseline biometry in eyes with pediatric cataract and a trend for longer AL and steeper K in cataract eyes than aged-matched controls. The difference in AL means was significant in age group 2-4 years, and variances were significant across all age groups (p=0.018). Unilateral cataracts (n=49) showed a trend toward greater variability in biometry than bilateral cataracts, but this did not reach statistical significance.

CONCLUSION

Baseline biometry measures are more variable in eyes with pediatric cataract compared to age-matched controls with a trend toward longer AL and steeper K.

Optic Capture Without Anterior Vitrectomy in Pediatric Cataract Surgery

PURPOSE

To compare outcomes of 2 surgical techniques in children undergoing cataract surgery with intraocular lens (IOL) implantation: optic capture of IOL without anterior vitrectomy (AV) or in-the-bag IOL with AV.

DESIGN

Prospective randomized controlled trial.

METHODS

Patients were randomized to 2 groups: optic capture without AV (group 1) or in-the-bag implantation with AV (group 2). The following variables were compared: visual axis opacification (VAO), inflammatory deposits on IOL surface, anteroposterior synechia, IOL tilt and decentration, lenticular astigmatism, refractive prediction error, and posterior segment complications.

RESULTS

Fifty-one eyes of 37 children were investigated with a mean follow-up of 20.1±8.5 months. Group 1 and group 2 had mean ages of 59.2±32.6 and 46.5±21.9 months, respectively (P = .104). Three eyes in group 1 and 2 eyes in group 2 developed VAO (P = .656). Two eyes in group 1 and 5 eyes in group 2 developed anteroposterior synechia (P = .291). Six eyes in group 1 and 11 eyes in group 2 had inflammatory deposits on the IOL (P = .233). Both groups had similar IOL tilt and decentralization (for all meridians, P > .05). The absolute refractive prediction error was 0.55±0.34 diopter (D) and 0.53±0.3 D, respectively (P = .294). Each group had 1 eye with intraocular hypertension (P = .932).

CONCLUSION

The optic capture method was similar to the conventional technique in the quantitative evaluation of comprehensive data such as visual axis opacification, inflammatory sequelae, refractive outcomes, and IOL stability. The optic capture technique is an appealing option for pediatric cataract surgery because it eliminates the requirement for vitrectomy.

Accuracy of the SRK/T Formula in Pediatric Cataract Surgery

PURPOSE

Determining IOL power is an important step in achieving the desired postoperative refractive target, but this determination remains challenging, as currently the used formulas were developed using IOL power calculations derived from adults.

PATIENTS AND METHODS

This is a retrospective analytical study with the period of June 2018 to May 2019. All of the data were taken from medical records in referral tertiary eye hospital in Indonesia. All type of cataracts underwent uncomplicated surgeries and in-the-bag IOL implantation were included in this study, while aphakia, secondary IOL implantation, primary sulcus implantation, and history of ocular disorders were excluded. The data were analyzed using Wilcoxon sign-rank, paired t, and Kruskal-Wallis tests.

RESULTS

Sixty-seven patients (106 eyes) were found to meet the inclusion criteria, average age was 7.35 ± 4.61 years (1.00 to 17.00 years). Average targeted refraction was 1.69 ± 2.06 D (-0.38-+6.99 D), and spherical equivalent (actual postoperative refraction) was -0.90 ± 1.45 D (-4.38 to +2.75 D). There was statistically significant difference between preoperative targeted refraction and actual postoperative refraction (p < 0.001). Mean absolute prediction error (APE) in general was 1.34 ± 1.18 D, 1.22 ± 0.88 D (in short eyes), 1.52 ± 1.37 D (in moderate eyes), and 0.69 ± 0.52 D (in long eyes) (p = 0.202). Mean APE in age group <7 years old was 1.27 ± 1.18 D and ≥7 years-old was 1.42 ± 1.19 D (p = 0.429).

CONCLUSION

SRK/T formula is fairly accurate in calculating IOL power in pediatric cataract surgery. Mean APE in this study was within the range of accurate mean APE in pediatric patients despite differentiated axial length and age.

Long-term Results of Congenital Cataract Surgery with Primary Intraocular Lens Implantation: A Case-Control Study of Three Age Groups

Purpose

To analyze the results of ocular refraction at the age of 7 years in children after congenital cataract surgery with intraocular lens (IOL) implantation.

Methods

A study of ocular biometric data of 143 eyes who underwent lens aspiration with IOL implantation in unilateral (23 eyes) and bilateral (60 eyes) congenital cataracts was performed. All children were divided into groups according to the age categories at the time of surgery: Group A (0-12 months) - 43 eyes; Group B (12-36 months) - 45 eyes; and Group C (older than 36 months) - 55 eyes. An empirical reduction of the implanted IOL power was performed: an undercorrection of 20% in children aged 0 to 36 months and 10% less in children aged 36 to 60 months.

Results

By age 7 years, the mean elongation ± standard deviation (SD) in Group A was 3.93 ± 1.64 mm, 2.13 ± 0.94 mm in Group B, and 0.95 ± 0.76 mm in Group C (18.7%, 9.5%, and 4.1% of the baseline axial length, respectively). There was no significant difference in axial elongation between unilateral and bilateral congenital cataracts (P = 0.32). The mean absolute refraction error (MAE) at last examination was 3.99 ± 2.12 diopter (D), 2.46 ± 1.48 D, and 1.59 ± 1.31 D in Groups A, B, and C, respectively. In infants younger than 7 months of age, by age 7 years, the mean elongation ± SD was 3.27 ± 2.86 mm (25.5%) and MAE was 3.44 ± 2.1 D. The prevalence of preoperative corneal astigmatism of 1.0 D or more was 48.95%, 2.0 D or more was 27.27%, and 3.0 D or more was 5.6%. There was no significant difference in preoperative corneal astigmatism between unilateral (1.62 ± 0.77 D) and bilateral (1.78 ± 0.90 D) congenital cataracts (P = 0.56, 95% confidence interval = -0.50-0.28). Best-corrected visual acuity (BCVA) more than 20/40 was in 53.49%, 55.55%, and 74.54% in Groups A, B, and C, respectively.

Conclusions

Although IOL power was calculated in accordance with children's age, at the age of 7 years, there was a different degree of ametropia because of the biometric changes of the growing eye, and a higher rate of ametropia was observed more in the younger age group than in the elder age groups.

Accuracy of newer generation intraocular lens power calculation formulas in pediatric cataract patients

PURPOSE

To evaluate the accuracy of newer generation intraocular lens (IOL) power calculation formulas (EVO 2.0 and Kane) with established formulas (Barrett Universal II, Haigis and SRK/T) in pediatric cataract patients.

METHODS

Retrospective study. We enrolled 110 eyes (110 patients) in Eye Hospital of Wenzhou Medical University. All patients underwent uneventful cataract surgery and implanted with posterior chamber IOL in the bag. We calculate the mean prediction errors (PE) and percentage within 1 diopter (D) at 1 month to assess the accuracy, and percentage > 2D was defined as prediction accident. Then, we performed subgroup analysis according to age and axial length (AL).

RESULTS

The mean age and AL were 37.45 ± 23.28 months and 21.16 ± 1.29 mm. The mean PE for all patients was as follows: Barrett (- 0.30), EVO (0.18), Haigis (- 0.74), Kane (- 0.36), and SRK/T (0.58), p < 0.001. In addition, EVO and SRK/T formulas were relatively accurate in patients younger than 24 months and with AL ≤ 21 mm, while EVO got lower prediction accident rate than SRK/T (3/41 vs 8/41, 4/52 vs 5/52). Moreover, Barrett, EVO, and Kane formulas achieved better accuracy and lower prediction accident rate in patients older than 24 months and with AL > 21 mm (both > 51/69 and 43/58, and < 3/69 and 3/58).

CONCLUSIONS

In patients older than 24 months and with AL > 21 mm, Barrett, EVO, and Kane formulas were relatively accurate, while in patients younger than 24 months and with AL ≤ 21 mm, EVO was more accurate, followed by SRK/T formula.

Effective lens position and pseudophakic refraction prediction error at 10½ years of age in the Infant Aphakia Treatment Study

BACKGROUND

The refraction prediction error (PE) for infants with intraocular lens (IOL) implantation is large, possibly related to an effective lens position (ELP) that is different than in adult eyes. If these eyes still have nonadult ELPs as they age, this could result in persistently large PE. We aimed to determine whether ELP or biometry at age 10½ years correlated with PE in children enrolled in the Infant Aphakia Treatment Study (IATS).

METHODS

We compared the measured refraction of eyes randomized to primary IOL implantation to the "predicted refraction" calculated by the Holladay 1 formula, based on biometry at age 10½ years. Eyes with incomplete data or IOL exchange were excluded. The PE (predicted - measured refraction) and absolute PE were calculated. Measured anterior chamber depth (ACD) was used to assess the effect of ELP on PE. Multiple regression analysis was performed on absolute PE versus axial length, corneal power, rate of refractive growth, refractive error, and best-corrected visual acuity.

RESULTS

Forty-three eyes were included. The PE was 0.63 ± 1.68 D; median absolute PE, 0.85 D (IQR, 1.83 D). The median absolute PE was greater when the measured ACD was used to calculate predicted refraction instead of the standard A-constant (1.88 D [IQR, 1.72] D vs 0.85 D [IQR, 1.83], resp. [P = 0.03]). Absolute PE was not significantly correlated with any other parameter.

CONCLUSIONS

Variations in ELP did not contribute significantly to PE 10 years after infant cataract surgery.

Evaluation of IOL power calculation with the Kane formula for pediatric cataract surgery

PURPOSE

To assess the accuracy of the Kane formula for intraocular lens (IOL) power calculation in the pediatric population.

METHODS

The charts of pediatric patients who underwent cataract surgery with in-the-bag IOL implantation with one of two IOL models (SA60AT or MA60AC) between 2012 and 2018 in The Hospital for Sick Children, Toronto, Ontario, CanFada, were retrospectively reviewed. The accuracy of IOL power calculation with the Kane formula was evaluated in comparison with the Barrett Universal II (BUII), Haigis, Hoffer Q, Holladay 1, and Sanders-Retzlaff-Kraff Theoretical (SRK/T) formulas.

RESULTS

Sixty-two eyes of 62 patients aged 6.2 (IQR 3.2-9.2) years were included. The SD values of the prediction error obtained by Kane (1.38) were comparable with those by BUII (1.34), Hoffer Q (1.37), SRK/T (1.40), Holaday 1 (1.41), and Haigis (1.50), all p > 0.05. A significant difference was observed between the Hoffer Q and Haigis formulas (p = 0.039). No differences in the median and mean absolute errors were found between the Kane formula (0.54 D and 0.91 ± 1.04 D) and BUII (0.50 D and 0.88 ± 1.00 D), Hoffer Q (0.48 D and 0.88 ± 1.05 D), SRK/T (0.72 D and 0.97 ± 1.00 D), Holladay 1 (0.63 D and 0.94 ± 1.05 D), and Haigis (0.57 D and 0.98 ± 1.13 D), p = 0.099.

CONCLUSION

This is the first study to investigate the Kane formula in pediatric cataract surgery. Our results place the Kane among the noteworthy IOL power calculation formulas in this age group, offering an additional means for improving IOL calculation in pediatric cataract surgery. The heteroscedastic statistical method was first implemented to evaluate formulas' predictability in children.

Challenges in pediatric cataract surgery: comparison of intraocular lens power calculation formulas using optical biometry

PURPOSE

Comparison of the accuracy of intraocular lens (IOL) power calculation formulas (SRK II, SRK/T, Holladay 1, Hoffer Q and Barrett II Universal, Haigis) in pediatric cataract surgery using optical biometry.

METHOD

This prospective study included seventy eyes of 70 patients between ages of 3-15 who had undergone cataract surgery with IOL implantation. Anterior segment parameters and axial length (AL) were measured with an optical biometer. Barrett II Universal formula results were used to determine the diopter of implanted IOL. Postoperative refraction was taken at first month, and differences from the estimated refractive value [mean absolute predictive error (APE)] were compared between formulas. Formulas were also compared according to AL.

RESULTS

The lowest APE was achieved with Barrett II formula (0.64 ± 0.73D) and the highest with Haigis formula (1.06 ± 0.84D) in the whole study population (p < 0.01). APE values were lowest with Holladay 1 (0.79 ± 0.71D) and highest with Haigis (1.44 ± 0.92D) in patients with an AL ≤ 22 mm; lowest APE was achieved with Barrett II (0.47 ± 0.54D) and highest with Haigis (0.84 ± 0.72D) in patients with an AL > 22 mm.

CONCLUSION

Barrett II formula had the best results in eyes with average AL, and SRK/T and Holladay 1 formulas were better in eyes with shorter AL. Haigis formula statistically had the highest predictive error in all formulas.

Accuracy of Intraocular Lens Power Calculation Formulas in Pediatric Cataract Patients: A Systematic Review and Meta-Analysis

Background: Among the various intraocular lens (IOL) power calculation formulas available in clinical settings, which one can yield more accurate results is still inconclusive. We performed a meta-analysis to compare the accuracy of the IOL power calculation formulas used for pediatric cataract patients.

Methods: Observational cohort studies published through April 2021 were systematically searched in PubMed, Web of Science, and EMBASE databases. For each included study, the mean differences of the mean prediction error and mean absolute prediction error (APE) were analyzed and compared using the random-effects model.

Results: Twelve studies involving 1,647 eyes were enrolled in the meta-analysis, and five formulas were compared: Holladay 1, Holladay 2, Hoffer Q, SRK/T, and SRK II. Holladay 1 exhibited the smallest APE (0.97; 95% confidence interval [CI]: 0.92–1.03). For the patients with an axial length (AL) less than 22 mm, SRK/T showed a significantly smaller APE than SRK II (mean difference [MD]: −0.37; 95% CI: −0.63 to −0.12). For the patients younger than 24 months, SRK/T had a significantly smaller APE than Hoffer Q (MD: −0.28; 95% CI: −0.51 to −0.06). For the patients aged 24–60 months, SRK/T presented a significantly smaller APE than Holladay 2 (MD: −0.60; 95% CI: −0.93 to −0.26).

Conclusion: Due to the rapid growth and high variability of pediatric eyes, the formulas for IOL calculation should be considered according to clinical parameters such as age and AL. The evidence obtained supported the accuracy and reliability of SRK/T under certain conditions.

Systematic Review Registration: PROSPERO, identifier: INPLASY202190077.

An ensemble-based approach for estimating personalized intraocular lens power

The fundamental difference between modern formulae for intraocular lens (IOL) power calculation lies on the single ad hoc regression model they use to estimate the effective lens position (ELP). The ELP is very difficult to predict and its estimation is considered critical for an accurate prediction of the required IOL power of the lens to be implanted during cataract surgery. Hence, more advanced prediction techniques, which improve the prediction accuracy of the ELP, could play a decisive role in improving patient refractive outcomes. This study introduced a new approach for the calculation of personalized IOL power, which used an ensemble of regression models to devise a more accurate and robust prediction of the ELP. The concept of cross-validation was used to rigorously assess the performance of the devised formula against the most commonly used and published formulae. The results from this study show that overall, the proposed approach outperforms the most commonly used modern formulae (namely, Haigis, Holladay I, Hoffer Q and SRK/T) in terms of mean absolute prediction errors and prediction accuracy i.e., the percentage of eyes within ± 0.5D and ± 1 D ranges of prediction, for various ranges of axial lengths of the eyes. The new formula proposed in this study exhibited some promising features in terms of robustness. This enables the new formula to cope with variations in the axial length, the pre-operative anterior chamber depth and the keratometry readings of the corneal power; hence mitigating the impact of their measurement accuracy. Furthermore, the new formula performed well for both monofocal and multifocal lenses.

Comparison of the Barrett Universal II formula to previous generation formulae for paediatric cataract surgery

PURPOSE

To compare the accuracy of the Barrett Universal II (BUII) five-variable formula to previous generation formulae in calculating intraocular lens (IOL) power following paediatric cataract extraction.

METHODS

Retrospective study of consecutive paediatric patients who underwent uneventful cataract extraction surgery along with in-the-bag IOL implantation between 2012 and 2018 in the Hospital for Sick Children, Toronto, Ontario, Canada. The accuracy of five different IOL formulae, including the BUII, Sanders-Retzlaff-Kraff Theoretical (SRK/T), Holladay I, Hoffer Q and Haigis, was evaluated. Constant optimization was performed for each IOL and for each formula separately. Mean prediction error (PE) and the mean and median absolute PE (APE) were calculated for the five different IOL formulae investigated.

RESULTS

Sixty-six eyes of 66 children (59% males) with a median age at surgery of 6.2 years (IQR, 3.2-9.2 years) were included in the study. The mean IOL power that was implanted was 23.3 ± 5.1 D (range; 12.0-39.0 D). Overall, the BUII had a comparable median APE to the Hoffer Q, Holladay I, SRK/T and Haigis formulae (BUII: 0.49D versus 0.48D, 0.61D, 0.74D and 0.58D respectively; p = 0.205). The BUII, together with Hoffer Q, produced better predictability within 0.5D from target refraction compared with the SRK/T formula (BUII:51.5%, Hoffer Q:51.5% versus SRK/T:31.8%, p = 0.002 for both).

CONCLUSION

The BUII formula had comparable accuracy to other tested formulae and outperformed the SRK/T formula, when calculating IOL power within the 0.5D range from target refraction in paediatric eyes undergoing cataract surgery with in-the-bag IOL implantation.

Accuracy of IOL power calculation formulas in Marfan lens subluxation patients with in-the-bag IOLs and implantation of scleral-sutured single-eyelet modified capsular tension rings

PURPOSE

To investigate the accuracy of intraocular lens (IOL) formulas for the prediction of postoperative refraction in lens subluxation in Marfan syndrome.

SETTING

Eye and ENT Hospital of Fudan University, Shanghai, China.

DESIGN

Consecutive retrospective clinical observational case series.

METHODS

60 eligible eyes with lens subluxation from 39 young patients with Marfan syndrome (8.53 ± 4.38 years) underwent phacoemulsification combined with single-eyelet modified capsular tension ring (MCTR) and IOL implantation. The prediction error values with mean zero out (relative prediction error) and their absolute values (AE) were calculated.

RESULTS

Generally, the SRK/T formula with Wang-Koch (WK) adjustment had the lowest median AE at 0.418 diopters (D), and the Holladay 1 with WK adjustment had the lowest mean AE at 0.499 D. The median AE of the other 10 formulas, in order from lowest to highest, were Haigis with WK (0.494 D), Holladay 1 with WK (0.495 D), Hoffer Q with WK (0.508 D), Haigis (0.525 D), T2 (0.542 D), Hoffer Q (0.624 D), SRK/T and Holladay 1 (0.660 D), Super (0.680 D), and Barrett Universal II (0.714 D) formulas. Haigis formula was found to be statistically significantly different from SRK/T, Holladay 1, and Barrett Universal II (all 3 P < .001) but not Hoffer Q (P = .236) formula.

CONCLUSIONS

The Haigis formula was recommended for young Marfan lens subluxation patients with in-the-bag IOLs and scleral-sutured single-eyelet MCTR implantation. WK adjustments were successful in those cases where the axial length was longer than 25.0 mm.

Macular perfusion normative data acquired with optical coherence tomography angiography in healthy four-year-old Caucasian children

BACKGROUND

The purpose of this cross-sectional study involving healthy emmetropic four-year-old Caucasian children was to provide a macular perfusion normative database acquired with optical coherence tomography angiography (OCTA). One eye of each examinee underwent OCTA imaging. The following parameters were analyzed using AngioTool Image J software: vessels area (VA), vessels density (VD), total number of junctions (TNJ), junctions density (JD), total vessel length (TVL), average vessel length (AVL), total number of endpoints (TNEP), lacunarity (L), vessel diameter index (VDI), tortuosity (T) and foveal avascular zone (FAZ). Average central macular thickness (CMT) and average central macular volume (CMV) were measured.

RESULT

Sixty-two eyes of 62 children of average age 50.4 ± 3.8 months were examined. VA, VD, and T increased from the inner towards the outer layers of the retina. The intermediate capillary plexus had the highest JD and TNEP and narrowest FAZ. Retinal sexual differentiation was supported with higher values of the retinal VA, VDI and TNEP, and chorioretinal VA, VDI and L in males. The choriocapillaris presented with the highest VD, AVL, and T and the lowest L and TNEP.

CONCLUSION

The study provides the first detailed normative database of the macular vascular network in the youngest uniform cohort of emmetropic four-year-old children.

Predictive Value of Intraocular Lens Power Calculation Formulae in Children

Purpose

To compare the accuracy of IOL power calculation formulae in a large cohort of children who underwent IOL implantation.

Setting

Cairo University Children Hospital.

Design

Retrospective, case series.

Methods

A retrospective chart review of all children <14 years, who underwent primary or secondary IOL implantation in Cairo University Children Hospital from January 2016 to December 2019, was performed. Absolute prediction error (APE) was calculated for SRKII, SRK/T, Holladay I and Hoffer-Q formulae using the patients' AL, keratometric (K) readings, implanted IOL power and refraction done two months postoperatively.

Results

The study included 308 eyes of 255 patients with a mean age of 4.74 ± 3.19 years at the time of surgery. The mean K-reading was 43.42 ± 3.57 diopters (D) and mean AL was 22.01 ± 1.93 mm. The percentage of eyes with APE within 0.5D was 27.7% (85 eyes), 32.2% (99 eyes), 30.6% (94 eyes) and 25.4% (78 eyes) with SRK II, SRK/T, Holladay I and Hoffer-Q formulae, respectively. APE was significantly lower with the SRK/T formula (P≤0.004) and significantly higher with the Hoffer-Q formula (P≤ 0.002). There was a negative correlation between the age of the patient and the APE of the SRK II formula (P=0.02). Moreover, the SRK/T, Holladay and Hoffer-Q formulae APEs were affected by the average k-readings (P=0.019, 0.005 and 0.035) respectively.

Conclusion

The SRK/T and Holladay I formulae were the most predictable formulae in IOL power calculation in pediatric eyes.

Accuracy of a universal theoretical formula for power calculation in pediatric intraocular lens implantation

PURPOSE

To compare the accuracy of Barrett Universal II formula with other formulas (Holladay 2, Hoffer Q, and SRK/T formulas) in the prediction of postoperative refraction for pediatric intraocular lens implantation.

SETTING

Academic medical center/children's hospital, San Francisco, California.

DESIGN

Retrospective case series.

METHODS

Children aged 16 years or younger who underwent cataract extraction and IOL implantation (2012 to 2019) and had refraction assessed at 3 to 16 weeks postoperatively were included. Prediction error (PE) was calculated as postoperative mean spherical equivalent minus the target refraction. Mean, median, and standard deviation was calculated for PE and absolute PE. Performance across covariables (axial length, age, biometry type, keratometry, etc.) was studied, and a multivariate regression analysis was performed using a single prediction model for each formula.

RESULTS

Sixty-four eyes of 64 patients, aged 1.5 to 15.5 years, were included. Barrett Universal II formula had the lowest mean PE (-0.22 diopters [D]), SD (1.18 D), median PE (-0.26 D), and median absolute PE (0.71) compared with those of the other formulas. Holladay 2 formula performed similarly to Barrett Universal II formula, and SRK/T formula had the greatest mean PE (-0.50 D) and SD (1.22 D). Barrett Universal II formula predictions were stable across all variables.

CONCLUSIONS

Barrett Universal II formula demonstrated similar or superior performance when compared with other formulas in this pediatric study. Holladay 2 formula performed similarly to Barrett Universal II formula, and SRK/T formula had the least reliable performance, across several key biometric characteristics. Although PEs can be highly variable in pediatric populations, this study supports Barrett Universal II formula as a reasonable and reliable option for lens power calculation in children, including those with extreme biometric measurements.

[Risk factors and prognosis of the development of pseudophakic myopia in children]

Recent studies indicate the prevalence of myopic refraction in children with pseudophakia, which significantly reduces the functional results of treatment and may be an indication for replacing the intraocular lens (IOL). Therefore, studies conducted to achieve the target refraction in children with pseudophakia are relevant.

PURPOSE

To determine the risk factors for the prognosis of myopic refraction in children after extraction of congenital cataract and IOL implantation.

MATERIAL AND METHODS

The study presents the results of refraction examination in 69 (110 eyes) children aged 1 to 12 years 36 months after extraction of congenital cataract with implantation of soft IOL.

RESULTS

The obtained data of anamnesis, results of ophthalmological, echobiometric, clinical and laboratory studies were subjected to statistical processing assessing the significance of differences in outcomes depending on the impact of possible risk factors for the development of pseudophakic myopia; a regression logistic model and a ROC-curve were constructed.

CONCLUSION

According to the authors, reliable risk factors for the development of pseudophakic myopia in children can be such indicators as axial eye length at the time of IOL implantation exceeding the age norm by more than 0.2 mm; the child from the first pregnancy; the AL/CR ratio of ≥3.0; myopia on the paired eye; strabismus of more than 4 prism diopters; hereditary load; tension of eye's fibrous capsule: pressure of ≤180 mm Hg at the time of IOL implantation. The presented reliable factors, as well as a combination of less significant signs (the child being outside for less than 1 hour per day, intermarriage of the patient's parents, near-sight visual loads of more than 3 hours per day, the blood Ca level of less than 1.8 mmol/L) can be used for prognosis of the development of pseudophakic myopia and to help make adjustments in the management tactics for patients to achieve target refraction.

Outcome of cataract surgery in children affected by malignancies other than retinoblastoma with eye-lens radiation exposure

PURPOSE

To describe, retrospectively, the visual outcome, feasibility, and safety of cataract surgery in a pediatric population affected by iatrogenic cataract, secondary to systemic oncological treatment for malignancies other than retinoblastoma.

METHODS

Young patients, affected by radiation-induced cataract, who were referred to the San Paolo Ophthalmic Center in Padova between 2010 and 2017, were included in the study. All patients had previously received radiotherapy and/or chemotherapy treatment for malignancies, between 2004 and 2013. All medical records of infants who underwent cataract surgery were accurately reviewed.

RESULTS

Eighteen eyes out of 11 patients included in the study underwent cataract surgery. The mean age at surgery was 9.7 ± 3.6 years. The interval between tumor diagnosis and cataract development was around 3 years. Mean follow-up after surgery was 15.4 ± 6.3 months. All eyes underwent posterior chamber intraocular lens implantation, posterior capsulotomy, and anterior vitrectomy in one time surgery. No intraoperative complications were shown. Post-operatively, only one eye received laser capsulotomy due to posterior capsule opacification. At the end of follow up, best-corrected visual acuity was 20/20 (LogMAR 0) in all eyes and significantly improved (p < 0.01) compared to baseline.

CONCLUSIONS

Iatrogenic-cataract surgery in pediatric oncological patients is a safe and effective way to improve visual acuity. Posterior capsulotomy and anterior vitrectomy at the time of surgery reduce the rate of posterior lens opacification and guarantee an excellent visual acuity in these patients.

A-scan biometry, phacoemulsification, and foldable intraocular lens implantation in a young orangutan (Pongo pygmaeus)

Background:

Cataracts are the major cause of visual impairment in animals which can be curable by surgical treatment. Phacoemulsification is the standard technique for cataract treatment that is applied to almost all species with a high success rate.

Case Description:

A 2-year-old intact female orangutan (Pongo pygmaeus) was presented for the study having bilateral opacity of the lenses, for 2 weeks. Ophthalmic examination revealed mature cataract OU. Ocular biometry measurements using A-scan ultrasonography for appropriate intraocular lens (IOL) refractive power calculation were carried out. Electroretinography was applied to ensure retinal function is intact. The orangutan underwent phacoemulsification OU and +24 diopter IOL implantation OS to restore vision. IOL implantation was not carried out OD because of a posterior capsular tear. Retinoscopy after 3 weeks postoperatively revealed +2.0 diopters OS. The outcome of the cataract surgery was successful during 3 years follow-up. The orangutan lived with other orangutans and was alert with normal behavior such as catching food, climbing trees, and swinging hand over hand from one branch to another.

Conclusion:

Cataract surgery with phacoemulsification OU and adjusted IOL implantation OD was successful with few complications in this orangutan. Vision was restored with normal behavior, even though an adjusted IOL was inserted in only one eye.

Precision of bag-in-the-lens intraocular lens power calculation in different age groups of pediatric cataract patients: Report of the Giessen Pediatric Cataract Study Group

PURPOSE

To evaluate the precision of bag-in-the-lens intraocular lens (BIL IOL) power calculation in different age groups of pediatric cataract patients.

SETTINGS

Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany.

DESIGN

Retrospective nonrandomized consecutive case series.

METHODS

Pediatric patients diagnosed with cataract and operated with BIL IOL implantation were divided into 4 age groups: Group 1 (0 to 3 months), Group 2 (>3 months, <12 months), Group 3 (12 to 36 months), and Group 4 (>36 months to 17 years). BIL IOL power was calculated with the SRK/T formula. The prediction error (PE) was defined as the absolute difference between the preoperative selected target and postoperative achieved refraction. The impact of age at the time of surgery, axial length (AL), keratometry, and corneal astigmatism on PE was analyzed.

RESULTS

The study comprised 87 eyes of 56 pediatric patients. The mean and median PEs for the entire group were 1.79 diopters (D) and 1.23 D, respectively. The mean PE in each age group was: 3.43 D in Group 1, 2.14 D in Group 2, 1.60 D in Group 3, and 1.33 D in Group 4. The mean PE in eyes with ALs shorter than 20 mm was 2.67 D, and 1.44 D in eyes with an AL of 20 mm or longer. The mean PE in eyes with corneal radii less than 7.3 mm was 2.45 D, and 1.66 D in eyes with corneal radii of 7.3 mm or more. In the age and AL subgroups, the PE differences were statistically significant (P < .05).

CONCLUSIONS

The PE was larger in the youngest study group, and it decreased gradually with age and in eyes with ALs shorter than 20 mm. The PE has to be considered during BIL IOL power calculation in children.

Cataract management in children: a review of the literature and current practice across five large UK centres

Congenital and childhood cataracts are uncommon but regularly seen in the clinics of most paediatric ophthalmology teams in the UK. They are often associated with profound visual loss and a large proportion have a genetic aetiology, some with significant extra-ocular comorbidities. Optimal diagnosis and treatment typically require close collaboration within multidisciplinary teams. Surgery remains the mainstay of treatment. A variety of surgical techniques, timings of intervention and options for optical correction have been advocated making management seem complex for those seeing affected children infrequently. This paper summarises the proceedings of two recent RCOphth paediatric cataract study days, provides a literature review and describes the current UK 'state of play' in the management of paediatric cataracts.

Comparison of the Accuracy of IOL Power Calculation Formulas for Pediatric Eyes in Children of Different Ages

Purpose

This study aims to compare the accuracy of five intraocular lens (IOL) power calculation formulas (SRK/T, Hoffer Q, Holladay 1, Haigis, and Holladay 2) for pediatric eyes in children of different ages.

Methods

In this prospective study, patients who received cataract surgery and IOL implantation in the capsular bag were enrolled. We compared the calculation accuracy of 5 formulas at 1 month postoperatively and performed subgroup analysis with the patients divided into three groups according to their ages at the time of surgery as follows: group 1 (age ≤ 2 years, 35 eyes), group 2 (2 years < age < 5 years, 38 eyes), and group 3 (age > 5 years, 29 eyes).

Results

75 patients (102 eyes) were enrolled in this study. The Haigis formula got the smallest PE among all formulas in all three groups. With regard to APE, there were no statistical differences among the formulas except group 2, with the SRK/T formula a little smaller, the Holladay 2 formula a little larger in group 1, and the Haigis formula a little smaller in group 3. In group 2, the Haigis formula had the lowest APE (0.87 ± 0.61 D), while the Holladay 2 formula had the largest (1.71 ± 1.20 D, p < 0.001), followed by the Holladay 1 formula (1.51 ± 1.07 D, p=0.002). On comparing the percentage of APE within 0.5 D and 1.0 D obtained with 5 formulas in each group, there were no statistical differences. The SRK/T formula and the Holladay 1 formula showed the highest percentage (40.00% and 60.00%) in group 1. While the Haigis formula got the highest percentage in less than 0.5 D (34.21%) and less than 1 D (60.53%) in group 2. In group 3, the Holladay 2 formula and the Haigis formula got the highest percentage less than 0.5 D (58.62%) and less than 1 D (79.31%). The multiple linear regression indicated that the age at the time of surgery was a significant factor affecting the accuracy of APE; after removing the age, AL was the only factor that affected the accuracy of APE.

Conclusion

The SRK/T and the Holladay 1 formulas were relatively accurate in patients younger than 2 years old, while the Haigis formula performed better in patients older than 2.

Update on Intraocular Lens Formulas and Calculations

Investigators, scientists, and physicians continue to develop new methods of intraocular lens (IOL) calculation to improve the refractive accuracy after cataract surgery. To gain more accurate prediction of IOL power, vergence lens formulas have incorporated additional biometric variables, such as anterior chamber depth, lens thickness, white-to-white measurement, and even age in some algorithms. Newer formulas diverge from their classic regression and vergence-based predecessors and increasingly utilize techniques such as exact ray-tracing data, more modern regression models, and artificial intelligence. This review provides an update on recent literature comparing the commonly used third- and fourth-generation IOL formulas with newer generation formulas. Refractive outcomes with newer formulas are increasingly more and more accurate, so it is important for ophthalmologists to be aware of the various options for choosing IOL power. Historically, refractive outcomes have been especially unpredictable in patients with unusual biometry, corneal ectasia, a history of refractive surgery, and in pediatric patients. Refractive outcomes in these patient populations are improving. Improved biometry technology is also allowing for improved refractive outcomes and surgery planning convenience with the availability of newer formulas on various biometry platforms. It is crucial for surgeons to understand and utilize the most accurate formulas for their patients to provide the highest quality of care.

Accuracy of 8 intraocular lens power calculation formulas in pediatric cataract patients

PURPOSE

To compare the accuracy of the eight formulas for intraocular lens (IOL) power calculation in pediatric cataract patients.

METHODS

A retrospective study. A total of 68 eyes (68 patients) that underwent uneventful cataract surgery and posterior chamber IOL implantation in the capsular bag were enrolled. We compared the calculation accuracy of the 8 formulas at 1 month postoperatively and performed subgroup analysis according to age or axial length (AL).

RESULTS

The mean age at surgery was 34.07 ± 24.60 months and mean AL was 21.12 ± 1.42 mm. The mean prediction errors (PE) of eight formulas for all patients were as follows: SRK II (- 0.66), SRK/T (- 0.44), Holladay 1 (- 0.36), Hoffer Q (- 0.09), Olsen (0.71), Barrett (0.37), Holladay 2 (- 0.70), and Haigis (0.50). There was significant difference among the 8 formulas (p < 0.0001), while no significant difference of absolute PE was found among the 8 formulas in all patients (p = 0.053). Moreover, in patients younger than 2 years old or with AL ≤ 21 mm, SRK/T formula was relatively accurate in 34% and 39% of eyes, respectively. While in patients older than 2 or with AL > 21 mm, Barrett and Haigis formulas were better (58% and 47% for Barrett, 52% and 53% for Haigis).

CONCLUSION

Overall, in patients younger than 2 years old or with AL ≤ 21 mm, SRK/T formulas were relatively accurate, while Barrett and Haigis formulas were better in patients older than 2 or with AL > 21 mm.

Accuracy of intraocular lens power calculations in paediatric eyes

IMPORTANCE

There is no clear consensus on which intraocular lens (IOL) power calculation formula provides the best refractive prediction in the paediatric population.

BACKGROUND

To evaluate the predictability of desired postoperative refractive outcomes by using six IOL formulas in paediatric cataract cases.

DESIGN

Retrospective case series.

PARTICIPANTS

A total of 377 eyes in 377 paediatric patients (<13 years of age) who received primary IOL implants in the capsular bag.

METHODS

This study utilized formulas, namely, SRK II, SRK/T, Hoffer Q, Holladay 1, T2 and Super formula. Prediction errors were calculated based on the difference between the postoperative refraction and the refraction predicted by each formula.

MAIN OUTCOME MEASURES

The mean prediction error, mean absolute error, median absolute error, percentages of eyes within the prediction errors of ±0.50 D, ±1.00 D and ± 2.00 D.

RESULTS

The mean axial length was 22.48 ± 1.91 mm (<22.0 mm for 161 eyes). The average age at surgery was 55.21 ± 28.01 months (<24 months for 37 eyes). The mean prediction error was positive (hyperopic error) with all formulas. Compared to the other IOL power formulas, SRK II showed significantly higher absolute errors (P < .001). Hoffer Q and Holladay 1 generated the least absolute error, followed closely by Super formula. Multiple logistic analyses indicated that age at time of surgery was an independent factor significantly contributing to the refractive surprise using all formulas.

CONCLUSIONS AND RELEVANCE

SRK II was the least predictable formula in this study. HofferQ and Holladay 1 yielded the best predictive values.

[Factors influencing target refraction in children with pseudophakia after extraction of congenital cataract]

The article describes the factors affecting the target refraction of pseudophakic eyes of children after extraction of congenital cataracts. The factors include features of the echobiometric parameters of the eye, refraction, comorbidity of congenital cataracts and ocular pathologies, margins of error in calculating strength of the intraocular lens, localization and structure of the artificial lens, as well as correction of obscure or refractive amblyopia in pseudophakic eyes. Development of the algorithm for correction of residual refraction of pseudophakic eyes in children both before and after IOL implantation with consideration of each of those factors currently remains a relevant problem.

Accuracy of the refractive prediction determined by intraocular lens power calculation formulas in high myopia

Purpose:

Our study was conducted to evaluate and compare the accuracy of the refractive prediction determined by the calculation formulas for different intraocular lens (IOL) powers for high myopia.

Methods:

This study reviewed 217 eyes from 135 patients who had received cataract aspiration treatment and IOL implantation. The refractive mean numerical error (MNE) and mean absolute error (MAE) of the IOL power calculation formulas (SRK/T, Haigis, Holladay, Hoffer Q, and Barrett Universal II) were examined and compared. The MNE and MAE at different axial lengths (AL) were compared, and the percentage of every refractive error absolute value for each formula was calculated at ±0.25D, ±0.50D, ±1.00D, and ±2.00D.

Results:

In all, 98 patients were recruited into this study and 98 eyes of them were analyzed. We found that Barrett Universal II formula had the lowest MNE and MAE, SRK/T and Haigis formulas arrived at similar MNE and MAE, and the MNE and MAE calculated by Holladay and Hoffer Q formula were the highest. Barrett Universal II formulas have the lowest MAE among different AL patients, whereas it reached the highest percentage of refractive error absolute value within 0.5D in this study. The MAE of each formula is positively correlated with AL.

Conclusion:

Barrett Universal II formula rendered the lowest predictive error compared with SRK/T, Haigis, Holladay, and Hoffer Q formulas. Thus, Barrett Universal II formula may be regarded as a more reliable formula for high myopia.

Accuracy of new and standard intraocular lens power calculations formulae in Saudi pediatric patients

PURPOSE

The purpose of this study is to compare the accuracy of new generation formulas to standard formulas for intraocular lens (IOL) power calculations in pediatric patients.

SUBJECTS AND METHODS

This retrospective case series compared the postoperative refractions to the predicted refractions after lensectomy and IOL implantation in pediatric patients. Four new generation formulas (Haigis, Holladay II, Olsen, and Barrett Universal II) were compared to four standard formulas (Holladay I, Hoffer Q, SRK/T, and SRKII) 4. The absolute prediction error (APE) was calculated as the absolute difference between the actual postoperative spherical equivalent and predicted spherical equivalent). The Friedman test was used to evaluate the difference between formulas. P < 0.05 was statistically significant.

RESULTS

The study sample was comprised 44 eyes from 29 patients (20 males and 9 females) with median age at surgery of 2.85 years (2.04-6.14 years). The Holladay I and II, Barrett Universal II, SRK/T, SRKII, Olsen, and Hoffer Q formulas had comparable median APE (MedAPE) of 1.32 D (0.51-2.11 D), 1.34 D (0.82-1.94 D), 1.28 D (0.73-1.85 D), 1.26 D (0.60-2.08 D), 1.16 D (0.54-1.16 D), 1.34 D (0.80-1.98 D), and 1.27 D (0.63-2.08 D), respectively (P = 1.0). The Haigis formula had the statistically highest MedAPE of 2.00 D (1.27-3.04 D) (P < 0.001). More than 70% of eyes were within ±2.0 D for the Holladay I and II, Barrett Universal II, SRK/T, SRKII, Olsen, and Hoffer Q formulas. Fifty percent of eyes were within ±2.0 D for the Haigis formula.

CONCLUSION

New generation IOL formulas do not outperform standard IOL formulas in predicting postoperative refraction for pediatric patients.

Outcome of Sutured Scleral-Fixated Intraocular Lens in Blunt and Penetrating Trauma in Children

BACKGROUND AND OBJECTIVE

To determine the anatomical and functional outcomes of sutured scleral-fixated intraocular lens (SSFIOL) implantation in children with blunt and penetrating injuries to the eye.

PATIENTS AND METHODS

This is a retrospective, interventional case series study. Case records of children who underwent SSFIOL implantation in a tertiary eye care facility for traumatic aphakia, cataract, or subluxation were screened. Relevant data on demographics, visual acuity (VA) outcomes, and complications and their management were collected. Results for blunt and penetrating trauma were compared.

RESULTS

There was stability or improvement of vision in 88.9% of eyes during the follow-up period. Young age at time of trauma (P = .031) and SSFIOL implantation (P = .002), history of retinal detachment (RD) before SSFIOL implantation (P = .019), poor preoperative best-corrected VA (BCVA) (P = .004), and development of RD in the follow-up period (P = .046) were independent risk factors for low final BCVA on univariate regression analysis. RD rate was 6.53% and was comparable in open and closed globe injuries. Intraocular lens (IOL) dislocation rate was 3.9%, and probability of survival was higher for open globe (0.78) as compared to closed globe (0.64) injuries (P = .042).

CONCLUSIONS

SSFIOL implantation results in good VA improvement in both open and closed globe injuries. RD remains an important vision-threatening complication. IOL dislocation is more likely to occur in closed globe injuries. A prospective study evaluating the outcomes would better elucidate the role of these IOLs. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:757-764.].

Cataract as Early Ocular Complication in Children and Adolescents with Type 1 Diabetes Mellitus

Cataract is a rare manifestation of ocular complication at an early phase of T1DM in the pediatric population. The pathophysiological mechanism of early diabetic cataract has not been fully understood; however, there are many theories about the possible etiology including osmotic damage, polyol pathway, and oxidative stress. The prevalence of early diabetic cataract in the population varies between 0.7 and 3.4% of children and adolescents with T1DM. The occurrence of diabetic cataract in most pediatric patients is the first sign of T1DM or occurs within 6 months of diagnosis of T1DM. Today, there are many experimental therapies for the treatment of diabetic cataract, but cataract surgery continues to be a gold standard in the treatment of diabetic cataract. Since the cataract is the leading cause of visual impairment in patients with T1DM, diabetic cataract requires an initial screening as well as continuous surveillance as a measure of prevention and this should be included in the guidelines of pediatric diabetes societies.

Pediatric cataract

Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference.

Analysis of Factors Associated with the Ocular Features of Congenital Cataract Children in the Shanghai Pediatric Cataract Study

Purpose

To investigate the ocular features of children with congenital cataract in a tertiary referral eye center in East China.

Methods

We retrospectively reviewed the clinical data of congenital cataract children who underwent cataract surgery between April 2009 and April 2014 at the Eye and ENT Hospital of Fudan University and identified factors associated with the axial length (AXL) and corneal curvature (K value).

Results

We included 493 children, 210 with unilateral and 283 with bilateral cataract. The mean AXL was 22.03 ± 1.97 mm and the mean K value was 43.61 ± 1.86 D. Age showed a linear correlation with AXL in unilateral cataract eyes and a logarithmic correlation with AXL in bilateral cataract eyes (both P < 0.001). AXL was longer and the K value was smaller (both P < 0.01) in boys than in girls after adjusting for age and cataract laterality. AXL was longer in unilateral cataract eyes than in bilateral cataract eyes after adjusting for age and gender (P = 0.004). In children with unilateral cataract, AXL was significantly longer in the affected eye than in the contralateral eye (P < 0.001).

Conclusion

Age, gender, and cataract laterality together contribute to the development of ocular features of congenital cataract children, especially for AXL.

Innovations in pediatric cataract surgery

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).

Current Status of IOL implantation in pediatric eyes: an update

INTRODUCTION

Pediatric cataracts are a huge problem worldwide, and with improving techniques and technology, the surgical treatment and postoperative visual rehabilitation are improving. Despite intraocular lenses(IOLs) being the standard of care for adult cataract surgery, this issue is still somewhat controversial, particularly in young children and infants due to lack of unequivocal evidence. This review therefore summarises the findings from recent studies on the aspect of IOL implantation in pediatric eyes. Areas covered: An extensive literature search was undertaken for published articles on congenital/developmental pediatric cataracts, and IOL implantation, where literature pertinent to traumatic and subluxated cataracts was not included in the review. Pubmed was used for literature search, and keywords entered were : pediatric, cataract surgery, intraocular lens, persistent fetal vasculature, outcomes, complications, visual performance with intraocular lenses. Expert commentary: Recent literature supports IOL implantation in most cases of congenital / developmental pediatric cataracts, and it seems like the way forward. However, the jury is still out on IOL implantation in infants, particularly in bilateral cataracts. Thus, surgeons must be extremely cautious in planning primary IOL implantation in infant eyes, and if they do perform IOL implantation, rigorous followup is mandatory.