| Objective: To evaluate the safety and efficacy of intraocular lens(IOL)power calculation in congenital cataract age ≤5 years based on surgery age and axial lengths.Methods: Records from June 2009 to February 2017 were retrospectively reviewed for 71 eyes of 42 patients who underwent cataract surgery with primary or secondary intraocular lens implantation for congenital cataract age ≤5 years.Keratometry were performed who cooperative by auto-keratometry.The patients who not able to acquire keratometry,the keratometry was replaced with 43.0D to calculate IOL power.According to different length of axial lengths,different IOL calculation formulas are selected.Target refractive =(7-age(y))D.The final power IOL was adjusted according to the axial lengths compared with normal children of same age.Best corrected distance visual acuity(BCDVA),the power IOL,the spherical equivalent(SE)of postoperative within 3 months and last follow-up,myopia drift,refractive anisometropia,axial lengths and keratometry of preoperative and last follow-up were collected.SE = spherical refractive error + cylinder refractive error/2.The myopic shift = SE at last follow-up-SE at postoperative within 3 months.Refractive anisometropia was defined as the bilateral difference of refractive error in SE ≥1.0D,interocular SE difference ≥2.50 D was classified into theResults:1.The median of BCDVA was 0.70LogMAR(2.00 LogMAR,0LogMAR).The distribution of BCDVA: the BCDVA>0.5 had 7eyes(10%),the BCDVA rage from 0.3 between 0.5 had 23 eyes(32%),the BCDVA <0.3 had 41 eyes(58%).2.Refractive status(1)The median of last follow-up of SE was 1.5D(-8.5,6.0).Among them,emmetropia,hypermetropia and myopia were 20%,59% and 21%,respectively.Hypermetropia: 41% were mild hyperopia(+0.5< SE ≤ +3.0D),14% were moderate hyperopia(+3.0 < SE ≤ +5.0D)and 4% were high hyperopia(SE>+5.0D).Myopic: 13% were mild myopia(-3.0 ≤ SE <-0.5D),6% were moderate myopia(-6.0 ≤ SE <-3.0D),3% were high myopia(SE<-6.0D).(2)The average SE of patients aged 2~3,3~4,4~5,5~6,6~7 and 7~9 years old were 2.93 ± 1.23 D,1.73 ± 1.54 D,1.07 ± 3.14 D,1.08 ± 2.11 D,-0.45 ± 5.03 D,0.04 ± 1.83 D respectively,which no significant difference compared with normal children of same age(p >0.05).(3)There was no significant difference in average SE between the two groups at surgery age ≤2(SE:1.13D(-8.5,6.0))and 2~5 years old(SE:1.63D(-3.25,5.25))(p =0.17).(4)Myopia drift: The average annual myopic drift was varied in different surgery age,-1.06 D for <1 years old,-0.64 D for 1~2 years old,-0.22 D for 2~3years old,-0.59 D for 3 ~ 4 years old.(5)Refractive anisometropia: In 29 patients with bilateral cataract,59%severe anisometropia,interocular SE difference ≥1.00 D and <2.50 D wasclassified into the mild anisometropia.Statistical analysis was performed using SPSS 22.0 Statistics.13 patients with unilateral cataract,62% patients had mild refractive3.The power of IOL implantation: The median times of IOL implantation in 71 eyes of 42 patients was 21 months(6,47)and the average of IOL power was 21.41 ± 4.27 D,range from +8D to +30D.The final power IOL was adjusted according to the axial lengths: 43% eyes of surgery age ≤2 years old and 15%eyes of surgery in 2~5 years old implanted IOL power minus +2.0 ~ +7.0D and+3.0 ~ + 6.5D respectively after target refractive reserved.4.The axial lengths of last follow-up was significantly longer than preoperative(p=0).The average axial lengths was 21.36 ± 1.72 mm(18.57 ~26.07mm)in preoperative.The average axial lengths was 22.83±1.69 mm(19.22~ 27.80mm)in last follow-up.The axial lengths growth retardation of 9 eyes(13%)were observed in 5 cases.In the two cases,no balanced grow in binocular axial,and a severe refractive anisometropia were foud in the final follow-up.5.The IOL power was calculated with 43.0D as the K value,and IOL power was calculated with the actual K value,and SE were no significant difference compared with normal children of same age in the last follow-up.(1)Twenty-four eyes which had no beeen acquire keratometry,the keratometry were replaced with 43.0D to calculate IOL powers.The average SE of last follow-up was 0.68 ± 3.61 D(-8.5D ~ +4.75D).There was no significant difference compared with normal children of same age(p = 0.30).Four eye of2 cases in surgery age ≤2 years old,the IOL power was calculated with 43.0D,anisometropia and only one patient was at a severe refractive anisometropia.In patients had no refractive anisometropia,38% were mild refractiveanisometropia,and the patients with no refractive anisometropia and at a severe refractive anisometropia were 23% and 15% respectively.and the keratometry was 49.5D,49.5D,52.62 D,49.62 D respectively and SE was in moderate and high myopia at the last follow-up.(2)The IOL powers were calculated with the actual keratometry in twelve eyes.The average SE of last follow-up was 1.72 ± 2.15D(-3.23 D ~ +5.25D).There was no significant difference compared with normal children of same age(p=0.70).Conclusion: 1.The IOL power calculation based on surgery age and axial lengths was effective and safe for congenital cataract age ≤5 years old.2.The slow growth of axial lengths is the main factor of high hyperopia after surgery. |
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