Interocular axial length difference as a predictor of postoperative visual acuity after unilateral pediatric cataract extraction with primary IOL implantation

PurposeTo develop a model that aids in the preoperative determination of predisposition to poor postoperative visual prognosis, specifically investigating the relationship between preoperative interocular axial length difference (IALD) and postoperative visual acuity in unilateral cataracts.MethodsRetrospective chart review of 96 pediatric patients with unilateral cataracts. Subjects were included if they had cataract extraction with primary IOL implantation and were between age birth and 18 years at the time of surgery. Descriptive statistics and logistic regression were used in analysis.ResultsSixty-four subjects met all inclusion and exclusion criteria, had complete response and covariate data, and were used in analysis. Median postoperative visual acuity was 20/40, and median IALD was 0.74 mm. A multiple logistic regression model was constructed to predict the odds of poor postoperative visual acuity based on age at surgery, IALD, and compliance with amblyopia therapy (p = 0.005), where postoperative visual acuity was categorized as good (better than or equal to Snellen visual acuity 20/40) and fair/poor (worse than Snellen visual acuity 20/40). With increasing IALD and age at surgery the odds of poor postoperative visual acuity increased (OR = 1.93; 95% CLs, 0.94-3.95 and OR = 1.26, 95% CLs, 1.0−1.59, respectively, controlling for compliance with amblyopia therapy). There was an increase in the odds of a poor postoperative visual acuity among individuals with poor compliance to amblyopia therapy compared with those with good compliance (OR = 3.15, 95% CLs, 0.76-13.17).ConclusionsThere is a clinically important relationship between IALD and postoperative visual acuity. Better visual prognosis appears to be associated with a smaller IALD, younger age at surgery, and good compliance to amblyopia therapy.