Exponential myopic shift over 13 years in aphakic and pseudophakic eyes after congenital cataract surgery within 6 months of birth.

Abstract

To characterise longitudinal refractive changes from the early postoperative period through long-term follow-up after congenital cataract surgery performed within the first 6 months of life. Longitudinal refractive changes were analysed retrospectively in 219 eyes from 124 patients who underwent surgery at a mean age of 2.9±1.7 months, with a minimum follow-up of 10 years (mean: 13.6±2.3 years; range: 10-18 years). Inclusion required refraction within 1 month postoperatively, at several-month intervals during the first year, and annually thereafter. The cohort included 81 bilateral aphakia, 14 bilateral pseudophakia, 20 unilateral aphakia and nine unilateral pseudophakia cases. In both aphakia and pseudophakia, postoperative refractive change followed an exponential pattern, with pronounced early myopic shifts that progressed gradually thereafter. Plotting refractive change against the logarithm of elapsed postoperative time yielded a linear relationship (aphakia: r=-0.979, p<0.001, pseudophakia: r=-0.893, p<0.001). At the final visit, median myopic shift was -8.4 D (IQR, -11.2 to -5.5 D) in bilateral aphakia and -11.5 D (-17.9 to -7.5 D) in bilateral pseudophakia. In unilateral cases, median anisometropia (operated minus healthy contralateral eye) was -7.8 D (-16.6 to -2.3 D) in aphakia and -11.6 D (-16.9 to -9.6 D) in pseudophakia. Both aphakic and pseudophakic eyes after congenital cataract surgery exhibited an exponential myopic shift that began in the early postoperative period and continued over a decade.