LONG-TERM REFRACTIVE OUTCOME IN CONTACT LENS-CORRECTED APHAKIA AFTER BILATERAL PEDIATRIC LENSECTOMY

To report the long-term refractive outcome in contact lens-corrected aphakic eyes after lensectomy for pediatric cataract and to analyse its predictability.

Cooperating optician of the Department of Ophthalmology at the University Hospital of Ludwig-Maximilians-University (LMU) in Munich, Germany (WÖRLE.OPTIK SehkraftCentrum München GmbH, Munich, Germany).

We conducted a retrospective chart review of n=184 eyes corrected with contact lenses between 1998 and 2021 after having undergone lensectomy without primary intraocular lens implantation for pediatric bilateral cataract. The charts were reviewed for contact lens refractive power determined via retinoscopic overrefraction as well as target refraction. The spherical equivalent of the optimal refractive correction in the corneal plane (REF) was obtained by subtraction of target refraction from contact lens power. For intersubject-comparability, we performed pointwise logarithmic interpolation of the time-dependent REF data to the children’s respective birthdays. REF at age 4 years was compared to a prediction given by a simple logarithmic model based on REF at ages 1 and 2 (data available for 98 eyes).

Median age at first and last refractive exam was 0.3 years and 10.1 years, respectively. Median REF at ages 1, 2, 3, 4, 5, 10, 15 and 20 years was +23.5 dpt, +21.0 dpt, +19.4 dpt, +17.6 dpt, +17.5 dpt, +14.8 dpt, +13.0 dpt and +11.8 dpt, respectively. The average deviation of REF at age 4 years from the prediction was -0.1 dpt. However, only 17 of 98 eyes (17.3%) deviated less than or equal +/- 0.5dpt, while 73 eyes (74.5%) deviated more than +/- 1 dpt, and 56 eyes (57.1%) deviated more than +/- 2 dpt.

On average, long-term refractive results in pediatric aphakia after lensectomy can well be predicted by a simple logarithmic model. However, a high variance between the individual eyes poses a major obstacle to reliable prediction of long-term refractive results even after observation of individual past refractive data from the first two years of life. In a majority of cases, a deviation greater than +/- 2dpt from the predicted value was observed. The low certainty of these predictions should be taken into account when early secondary intraocular lens implantation is desired and should be clearly addressed with the parents during shared decision-making and informed consent.