Intraocular Lens Choice In Pediatric Cataract: A Modified Target Refraction Approach – A 10-Year Retrospective Cohort Study

To evaluate long-term refractive and visual outcomes of pediatric cataract surgery with intraocular lens (IOL) implantation using a modified target refraction strategy emmetropia or mild hyperopia rather than conventional substantial hyperopic target.

This retrospective cohort study included children <7 years who underwent lensectomy with primary or secondary IOL implantation between 2014 and 2024 at King Khaled Eye Specialist Hospital.

This retrospective cohort study included children <7 years who underwent lensectomy with primary or secondary IOL implantation between 2014 and 2024 at King Khaled Eye Specialist Hospital. Demographic, preoperative, and postoperative data were analyzed. Visual acuity (VA), cycloplegic refraction (CR), and axial length (AL) were assessed longitudinally up to 10 years. Success was defined as final AL within or below age- and sex-specific normative limits. Multivariate regression identified predictors of outcomes.

A total of 101 eyes(70.3% male)were analyzed, with median age at surgery of 36 months(IQR 24–48).Most cases were bilateral(91.1%)and congenital cataract was the most common diagnosis(64.4%).Mean preoperative AL was 22.05mm(SD 1.44).Mean IOL power was 22.95D(SD 4.42).Postoperative VA improved significantly from logMAR 0.42 at 1 month to 0.16 at 10 years(p<0.05 until year 6;non-significant at year 10 due to attrition).Mean CR remained stable without significant long-term myopic shift.Mean AL increased to 23.37mm at final follow-up (p < 0.001).At last review(n = 37),81.1% of eyes remained within or below normative AL limits.Multivariate analysis showed IOL power predicted final AL(p = 0.039);age at surgery was borderline significant(p = 0.047)

Targeting emmetropia or mild hyperopia in pediatric cataract surgery was associated with improved VA, minimal myopic shift, and physiologic AL growth. This strategy may reduce amblyopia risk in populations with limited compliance to optical correction.