Refractive change at 5 years in the Toddler Aphakia and Pseudophakia Study (TAPS).

Purpose: To report refractive change at age 5 years in pseudophakic eyes operated before 2 years of age.

Design: Retrospective case series at 10 Infant Aphakia Treatment Study (IATS) sites.

Participants: Children who underwent cataract surgery with primary intraocular lens placement during the IATS enrollment years, including infants 1 to <7 months of age with bilateral cataract and all children 7-24 months of age, regardless of laterality.

Methods: Change in spherical equivalent refractive error (diopters[D]) was calculated from 1-month postoperatively to 5 years of age and compared for unilateral and bilateral (first eye only) cases, and for 1 to <7 vs 7-24 months at surgery.

Main Outcome Measures: Refractive change (D) from surgery to age 5 years.

Results: 96 children were included: 50 unilateral (surgery 7-24 months of age); 46 bilateral (n=20, surgery at 1 to <7 months of age; n=26, at 7-24 months). Median refractive change was significantly greater for bilateral pseudophakic eyes operated at 1 to <7 months (7.50 D, range 2.5 to 15 D) vs. 7-24 months (1.94 D, range -1.88 to 7.75 D; P<0.001). For children aged 7-24 months at lensectomy, median change was similar between unilateral (3.25D, range -1.75 to 13.5 D) vs. bilateral cases (1.94D, range 1.88 to 7.75 D; P=0.053). By age 5 years, none of the pseudophakic eyes 1 to <7 months at surgery had <2.5D myopic shift, but 55% of bilateral and 25% of unilateral cases 7-24 months at surgery had < 2.5D myopic shift.

Conclusions: Greater magnitude and variability in refractive change was found in pseudophakic eyes operated at 1 to <7 months and for unilateral cases, which should be considered when choosing IOL power and initial post-operative target refraction for infants and toddlers.