Postoperative longitudinal refractive changes in children under 8 years of age with ectopia lentis and Marfan Syndrome

Abstract Purpose: To evaluate the postoperative longitudinal refractive changes in children under 8 years of age with ectopia lentis and Marfan Syndrome (MFS). Setting: Zhongshan ophthalmic center, Guangzhou, China. Design: Retrospective cohort study. Methods: Medical data of patients diagnosed with ectopia lentis and MFS that underwent surgery before 8 years old were collected. Refractive errors and ocular biometric parameters were collected before surgery and at each follow-up visit. Patients were stratified into groups according to age at surgery and only the eye operated upon first was selected. Multivariable analysis was performed to determine the association between refractive shift and potential risk factors. Results: In total, 54 eyes of 54 patients were enrolled. The median age at surgery was 6.21 years (Interquartile range [IQR], 5.25 to 6.85) and the median follow-up was 2.0 years (IQR, 1.2 to 2.8 years). At 8 years old, patients demonstrated a median myopic shift ranged from -1.75 diopters (D) (IQR, -2.75 to -1.00 D) for the 4-year-old group to -0.13 D (IQR, -0.50 to -0.06 D) for the 7-year-old group. Multivariable analysis showed greater myopic shift was associated with younger age at surgery ( P =0.004), male gender ( P =0.026) and shorter preoperative axis length ( P =0.005). Conclusion: A tendency toward increasing postoperative myopic was demonstrated in children with ectopia lentis and MFS, with the greatest myopic shift in the younger age groups. If the goal is to reach emmetropia by age 8, the immediate postoperative hypermetropic targets should be 1.75D for 4 years old, 1D for 5 years old, 0.5D for 6 years old, 0 to 0.25D for 7 years old.