Anisometropia at Age 7 After Bilateral Secondary Intraocular Lens Implantation at 2 to Younger than 6 Years for Pediatric Aphakia: The CCPMOH Report.

Purpose: To evaluate anisometropia at age 7 years after bilateral secondary intraocular lens (IOL) implantation in children with pediatric aphakia and to identify factors associated with long-term refractive symmetry. Design: A prospective observational cohort study. Participants: This study was conducted from 2014 to 2023 at a single center. Of 251 eligible children, 158 (316 eyes) who underwent lensectomy before age 2 and secondary IOL implantation between ages 2 and 6 were included. Methods: Participants were grouped by age at secondary IOL implantation: 2 to <3 years, 3 to <4 years, 4 to <5 years, and 5 to <6 years. Demographic and clinical data were collected, and refractive outcomes at postoperative 1 month and age 7 years were analyzed. All refractive outcomes were expressed as spherical equivalent (SE), calculated as the sphere plus half of the cylinder (SE = sphere + ½ cylinder). Main Outcome Measures: Interocular anisometropia at age 7 years, defined as the absolute interocular difference in SE. Results: At postoperative month 1, 77.2% of children had anisometropia <1.0 D. By age 7 years, this proportion decreased to 52.5%, and significant differences in anisometropia distribution were observed among age-at-implantation groups ( Conclusions: Interocular anisometropia tends to increase during childhood after bilateral secondary IOL implantation and is influenced by implantation timing, interocular axial length asymmetry, and early postoperative refractive status. Minimizing early postoperative anisometropia may be important for optimizing long-term refractive symmetry, and delayed secondary IOL implantation may be considered in children with marked interocular axial length asymmetry. Financial Disclosures: The authors have no proprietary or commercial interest in any materials discussed in this article.