Long-Term Refractive Changes In Pediatric Pseudophakic Eyes: A Longitudinal Analysis Of Axial Elongation And Myopic Drift After Cataract Surgery

To systematically analyze the patterns of refractive evolution and myopic drift in pediatric pseudophakic eyes (with intraocular lens implantation) following cataract surgery. By comparing these outcomes with healthy contralateral phakic eyes, the study aims to provide an evidence-based framework for long-term refractive management in children after cataract intervention.

The study was conducted at the Department of Ophthalmology, University City Hospital Affiliated to Chongqing Medical University, Chongqing, China. This clinical research environment specialized in pediatric anterior segment surgery and long-term postoperative refractive follow-up.

This was a longitudinal, controlled clinical observational study involving 60 children (aged 3–12 years) who underwent unilateral phacoemulsification with intraocular lens (IOL) implantation. The healthy contralateral eyes served as the control group. Data were collected at baseline and multiple postoperative intervals (1 week, and 1, 3, 6, 12, and 24 months). Key parameters included axial length (AL) measured via IOLMaster or A-scan ultrasound, spherical equivalent refraction (SER) via Teller cards or automated refraction, and best-corrected visual acuity (BCVA). A linear regression model analyzed axial elongation trends, and paired t-tests compared refractive parameters between eyes.

Over the 24-month follow-up, the mean axial length of pseudophakic eyes increased by 1.9 ± 0.6 mm, significantly exceeding the 1.2 ± 0.4 mm increase in contralateral healthy eyes ($P = 0.002$). Mean myopic drift in operated eyes was 2.8 ± 1.2 D (range: -0.5 to +5.5 D), which was significantly greater than the 1.1 ± 0.8 D observed in control eyes ($P < 0.001$). Axial elongation was most rapid during the first 3 months postoperatively (0.6 mm/month). Children aged $\le$ 5 years exhibited more pronounced myopic drift (3.5 ± 1.4 D vs. 2.1 ± 0.9 D, $P = 0.003$). IOL material and type (monofocal vs. multifocal) did not significantly correlate with the degree of drift ($P > 0.05$).

Significant myopic drift occurs in pediatric pseudophakic eyes, substantially outstripping the natural refractive changes in phakic eyes. This shift is most aggressive in the early postoperative period and is strongly age-dependent. Refractive monitoring should be maintained for at least 24 months, with more frequent follow-ups for younger children. Dynamic adjustment of corrective prescriptions and strategic timing of secondary refractive interventions are essential to optimizing long-term visual prognosis in pediatric cataract patients.