Stability of Astigmatism following Lensectomy for Pediatric Cataract

Abstract

Purpose : Toric intraocular lenses (IOLs) are being implanted in some children undergoing cataract surgery with IOL, but there are limited data concerning the natural history of astigmatism following pediatric lensectomy. We evaluated early postoperative and 5-year postoperative astigmatism in pseudophakic eyes of children.

Methods : In a prospective cohort with pediatric cataract surgery, 224 children (278 eyes) <13 (mean 5.5 ± 3.2) years of age underwent lensectomy with IOL implantation (158 of 278 [57%] were bilateral cases) and had refractions both in an early postoperative window (30 days to 1.5 years) and in a 5-year postoperative window (4 to 6 years). Refractions were performed by retinoscopy. Mean astigmatism (95% confidence interval [CI]) was calculated and proportions with ≥1 and ≥2 diopters(D) of astigmatism were compared between early postoperative and 5-year time-points, using generalized linear mixed models to adjust for correlation.

Results : For pseudophakic eyes (n=278) at early versus 5-year postoperative examinations, the proportion with ≥1D astigmatism increased from 63% (95% CI: 57% to 69%) to 74% (95% CI: 68% to 80%), and the proportion with ≥2 D astigmatism increased from 25% (95% CI: 20% to 31%) to 40% (95% CI: 34% to 46%). There were approximately 3 times greater odds of astigmatism ≥1D (adjusted OR=3.01, 95% CI 1.65- 5.48; P<.001) and astigmatism ≥2D (adjusted OR=2.93, 95% CI 1.78-4.83; P<.0001) at the 5-year visit as compared to the postoperative visit (Figure 1). Mean (95% CI) astigmatism was +1.23D (1.11 to 1.36) at the early postoperative exam and +1.61D (1.47 to 1.74) at the 5-year exam (mean change: +0.38D, 95% CI: 0.26 to 0.49). Of note, 127 eyes changed at least 0.75D, 94 (74%) with increasing and 33 (26%) with decreasing astigmatism (Figure 2). Of eyes with astigmatism at both timepoints, axis changes >10 degrees occurred in 82 of 206 eyes (40%, 95% CI 33%-47%).

Conclusions : The proportion of pseudophakic eyes with astigmatism increased by 11% during follow-up, with 74% having ≥1 D of astigmatism 5 years after surgery. However, the mean increase in astigmatism was less than 0.50D and some children had decreased astigmatism.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Figure 1. Distribution of astigmatism at post-operative and five-year exams in pseudophakic eyes (n=278)

 

Figure 2 – Change in astigmatism between post-operative and five-year exams in pseudophakic eyes (n=278).