Refractive Predictability After Pediatric Cataract Surgery: Is Our Iol Targeting Strategy Accurate?

To evaluate refractive prediction error in pediatric cataract surgery and assess the accuracy of current targeting strategies.

Tertiary pediatric ophthalmology service.

Retrospective review of pediatric cataract cases (age 2–12 years) undergoing primary intraocular lens implantation. IOL power was calculated using standard third-generation formulas with age-adjusted hyperopic targets. Postoperative spherical equivalent (SE) was compared with predicted refraction at 1 month and longitudinally over follow-up. Myopic shift was analyzed relative to age and axial length growth.

Initial mean prediction error remained within ±1.00 D in the majority of patients. Younger children (<6 years) demonstrated greater myopic progression over time compared to older age groups. Age-based hyperopic offset reduced long-term refractive drift but did not eliminate variability in axial elongation. Visual rehabilitation was satisfactory when refractive targets were appropriately individualized.

Refractive targeting in pediatric cataract requires growth-adjusted planning. Age-based hyperopic offset remains essential to avoid long-term high myopia.Current IOL targeting strategies provide acceptable short-term accuracy; however, refractive predictability in younger children remains influenced by axial growth. Refinement of pediatric-specific calculation models and dynamic growth adjustment algorithms may improve long-term refractive outcomes.