Résumé
The study aimed to describe myopic shift (MS) after intraocular lens (IOL) implantation in pediatric cataracts at Montpellier University Hospital, France, and to explore the association of MS with pre-operative ocular factors, to help define more accurate target refractions at the time of IOL implantation. Methods: this retrospective cohort study analyzed medical records of children who underwent cataract surgery with IOL implantation between 2015 and 2024 at the Gui de Chauliac University Hospital in Montpellier, France. Eligible participants included children with a diagnosis of congenital or secondary cataracts who were followed regularly for at least 3 years post-surgery. Exclusions included ineligibility for IOL implantation due to conditions such as microphthalmia or zonular instability. Axial length (AL) and keratometry measurements were obtained, and surgeries were standardized among four experienced surgeons. MS was calculated as the change in spherical equivalent from baseline to last follow-up. Statistical analyses included correlation analysis and ANOVA to evaluate associations between ocular factors, IOL types, and MS. Results: a total of 87 eyes from 72 children were analyzed: 31 eyes (35%) became myopic, with a negative spherical equivalent at the last visit, and in 9 eyes (10%), pathological myopia developed (spherical equivalent < -6.0 diopters [D]). The mean initial SE was 4.5±5.5 D, and the mean MS from baseline to last visit was -3.0±5.21 D. We found significant positive correlations between mean MS and mean pre-operative AL (Spearman coefficient = 0.42, p=0.01) and mean age at surgery (Spearman coefficient = 0.37, p < 0.001). ANOVA revealed significantly greater mean MS for Asphina IOLs versus some other IOLs and greater mean MS for conditions such as Down syndrome, aniridia, and corticosteroids-induced cataracts versus others. Conclusion: pre-operative AL and age at surgery significantly affected MS after pediatric cataract surgery with IOL implantation. Certain IOL types and cataract conditions also affected the degree of MS, which highlights the need for personalized management strategies. These findings underscore the importance of adjusting IOL power based on specific preoperative parameters to optimize long-term visual outcomes in children.