Accuracy of new-generation and traditional IOL power calculation formulas in pediatric primary implantation

Purpose: To compare the prediction accuracy of new-generation and traditional intraocular lens (IOL) power calculation formulas in pediatric primary IOL implantation and identify factors influencing refractive prediction errors. Setting: Zhongshan Ophthalmic Center, Guangzhou, China. Design: Retrospective consecutive case-series study. Methods: We calculated the prediction error (PE) for Holladay 1, SRK/T, Hoffer Q, Haigis, Barrett Universal II (BUII), Kane, Emmetropia Verifying Optical (EVO) 2.0 and Ladas Super Formula (LSF) in pediatric primary IOL implantation. Subgroup analyses were conducted based on age, axial length (AL), average keratometry (K), surgical procedures and IOL type. Multivariable regression analysis was used to identify factors associated with significant refractive surprise. Results: A total of 83 patients (108 eyes) were included in the study. Significant differences in both PE and absolute PE were observed among formulas (P <0.001). The SRK/T and Kane formulas demonstrated lower mean predicted error (ME) and median absolute error (MedAE), whereas LSF and Haigis formulas showed higher ME and MedAE respectively. Patients who were older age and had longer AL exhibited improved predictive accuracy. No significant differences in prediction accuracy were found between eyes with different surgical procedures or different IOL types. Multivariable regression analysis showed that younger age and shorter preoperative AL were predictors of significant refractive surprise across formulas. Conclusions: The predictive accuracy of IOL formulas in pediatric primary IOL implantation remains suboptimal, with the SRK/T and Kane formulas performing relatively better. Younger age and shorter AL remain major predictors of refractive surprise, while surgical procedures and IOL type show no significant association. Further development of pediatric-specific IOL power formulas is warranted.