Key Takeaways

• A study found that early after pediatric cataract surgery, operated eyes remained stable in AL/CR ratio and choroidal thickness, while healthy fellow eyes demonstrated expected age-related ocular growth
• Longitudinal coordination between axial elongation and choroidal remodeling appeared to be disrupted after surgery, potentially reflecting the loss of physiologic accommodation following IOL implantation

School-age children’s eyes remained structurally stable during the early period after cataract surgery, but the normal relationship between axial growth and choroidal changes appeared to be disrupted, according to a prospective cohort study published in the International Journal of Ophthalmology.¹

The findings suggest that the loss of accommodation following intraocular lens implantation may affect the mechanisms coordinating ocular growth. However, the researchers emphasized that longer-term studies are needed to determine the clinical significance of the changes.

Investigators at Beijing Children’s Hospital evaluated the effects of pediatric cataract surgery on the axial length-to-corneal radius ratio, or AL/CR ratio, and choroidal thickness. The AL/CR ratio is a biometric marker associated with refractive development and myopia, while the choroid has been implicated in the regulation of axial elongation.

The study enrolled school-age children who underwent phacoemulsification with intraocular lens implantation between September 2024 and February 2025. Axial length and corneal curvature were measured with the IOLMaster 700 (Zeiss), and choroidal thickness was assessed using swept-source optical coherence tomography.

The analysis included 50 eyes from 32 children. The surgical cohort consisted of 32 eyes, including 21 implanted with trifocal IOLs and 11 implanted with monofocal IOLs. Eighteen healthy fellow eyes from children with unilateral cataracts served as the comparison group.

Children receiving trifocal IOLs had a mean age of 8.38 years, compared with 7.55 years among those receiving monofocal lenses. The children whose healthy fellow eyes were included in the comparison group had a mean age of 8.22 years.

Before surgery, cataractous eyes had significantly shorter axial lengths than healthy fellow eyes. However, the difference in the AL/CR ratio was not statistically significant.

During postoperative follow-up, the operated eyes showed no significant changes in either the AL/CR ratio or choroidal thickness. In contrast, healthy fellow eyes demonstrated a significant increase in the AL/CR ratio and a significant reduction in choroidal thickness—changes consistent with the ongoing ocular growth expected in school-age children.

The investigators found no significant differences in the measured biometric or choroidal parameters between eyes implanted with trifocal and monofocal IOLs.

In the operated eyes, axial length and the AL/CR ratio were negatively correlated with central subfield choroidal thickness at 1 month and at the final follow-up. In other words, longer eyes and eyes with higher AL/CR ratios tended to have thinner central choroids. However, changes in axial length, AL/CR ratio, and choroidal thickness were not significantly correlated with one another over time. The authors interpreted this finding as evidence that cataract surgery may disrupt the normal longitudinal coordination between axial elongation and choroidal remodeling. They proposed that the loss of accommodative function following removal of the crystalline lens could contribute to this disruption. Accommodation has been associated with transient changes in axial length and choroidal thickness, and replacing the natural lens with an IOL eliminates the eye’s physiologic accommodative response.

The researchers cautioned that the findings reflect only the early postoperative period and were derived from a relatively small cohort. The use of healthy fellow eyes from unilateral cataract cases as the comparison group also may not fully account for differences between children with and without cataracts.

Despite those limitations, the study provides prospective data on ocular development after cataract surgery in a relatively understudied population. Longer follow-up will be necessary to determine whether the observed loss of coordinated structural change affects postoperative refractive development, axial elongation, or the magnitude of myopic shift in children.

Reference

1. Zheng LF, Zhao K, Ni SH, Leng F, Li L. Effects of pediatric cataract surgery on the axial length/corneal radius ratio and choroidal thickness in school-age children: a prospective cohort study. Int J Ophthalmol. 2026;19(7):1300-1307. doi:10.18240/ijo.2026.07.10