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    Keys to IOL power selection in pseudophakic children

    Highly variable myopia shifts can occur in pseudophakic children. IOL exchange seems to be an acceptable option for treating the high myopia that can develop with lens implantation in children.

    However, the use of IOLs in growing eyes remains controversial, and outcomes are uncertain because of lack of data, according to Courtney Kraus, MD.

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    An important factor to consider is the selection of the optimal IOL power to implant in a specific child. However, understanding the ocular growth and development in pediatric patients is necessary to ensure selection of the correct IOL power, explained Dr. Kraus, Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, and the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

    During the early months of life, the axial length has been shown to increase with age, roughly 4 mm in one study of postnatal growth during the first year, and slower growth during the infantile and juvenile periods up to 13 years of age (Gordon RA, Donzls PB. Arch Ophthalmol. 1985;103:784-789).

    “The progressive logarithmic increase after birth has significant impact on the postoperative refraction when an IOL of fixed power is implanted,” Dr. Kraus said. “Because of this, we adjust the targeted refractive outcome for IOL implantation in pediatric cataract patients based on age at the time of IOL implantation.”

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