Researchers have developed and validated a predictive model that may help identify children at greatest risk of developing high myopia after congenital cataract surgery with primary intraocular lens (IOL) implantation.
Published in the American Journal of Ophthalmology,1 the study found that children with a higher IOL-to-axial length (IOL/AL) ratio and an initial postoperative refraction of +0.75 D or less were around three times more likely to develop high myopia than those without these characteristics.
The researchers said the model could help clinicians personalise long-term follow-up and better counsel parents about future refractive outcomes.
Achieving good visual outcomes after congenital cataract surgery requires not only timely surgery but also ongoing management to reduce the risks of complications including amblyopia, secondary glaucoma, visual axis opacification, and refractive error, the authors wrote.
The retrospective study included 106 children who underwent congenital cataract surgery with primary IOL implantation 2003–2018. An independent cohort of 72 children treated at a second tertiary centre was used to externally validate the model. Mean follow-up was approximately eight years in both groups.
By the final follow-up visit, 59.4% of children in the primary cohort had developed high myopia, defined as a spherical equivalent of -6.00 D or greater.
Multivariable analysis identified two independent predictors of postoperative high myopia: a higher IOL/AL ratio and an initial postoperative spherical equivalent of +0.75 D or less. While shorter preoperative axial length was not an independent predictor, it was associated with a greater postoperative myopic shift.
Using age at surgery, IOL/AL ratio, and initial postoperative refraction, the investigators developed a nomogram to estimate an individual child’s probability of developing high myopia over 10 years. The model showed good predictive performance in both the original and external validation cohorts.
Children in the highest IOL/AL ratio group (greater than 1.32) were more than twice as likely to develop high myopia as those in the lowest group, even after adjusting for age at surgery and postoperative refraction.
The authors said the findings suggest the IOL/AL ratio may represent a novel predictor of postoperative high myopia and could enable earlier identification of infants at greatest risk, allowing clinicians to tailor postoperative monitoring and counselling.
Reference
- Liu E, Lin X, Zhu D, et al. Risk factors and predictive model for postoperative high myopia in children undergoing congenital cataract surgery with intraocular lens implantation. Am J Ophthalmol. 2026 Jun 13;290:70-81. doi: 10.1016/j.ajo.2026.06.010.
