Long-Term Refractive Outcomes Following Pediatric Cataract Surgery with Primary IOL Implantation

Objective: To evaluate long-term refractive outcomes following pediatric cataract surgery with primary intraocular lens (IOL) implantation. Materials and Methods: A retrospective review was conducted on children younger than 13 years who underwent cataract surgery with primary IOL implantation at Siriraj Hospital between 2000 and 2020, with a minimum follow-up of 5 years. Refractive data were converted to spherical equivalents. Linear mixed models were used to analyze refractive shifts across four age groups (1 to <2.5, 2.5 to <4, 4 to <7, and 7 to <13 years) and identify influencing factors. Results: The study included 71 eyes of 46 children, with a mean follow-up of 8.74 ± 3.01 years. The mean final refractive change ranged from -5.47 D (95% CI: -7.93, -3.01) in children aged 1 to <2.5 years to -1.33 D (95% CI: -1.99, -0.67) in those aged 7 to <13 years. Overall, only 30.99% of eyes achieved a final refraction within ±1.00 D of emmetropia. Multivariate analysis identified preoperative axial length (P = 0.005) and follow-up duration (P = 0.003) as significant predictors of refractive change. Conclusion: Younger age at surgery correlates with greater magnitude and variability of myopic shift. Standard guidelines should be adapted to target higher residual hyperopia to achieve optimal long-term emmetropic refraction.