Isolated Infantile Onset High Myopia: A Case Series with Long-Term Follow-Up.

PURPOSE Isolated infantile onset high myopia (IIOHM) is a rare phenomenon. Our aim is to describe the natural course of IIOHM based on a long-term follow-up.

METHODS All patients under 5 years of age diagnosed with bilateral spherical equivalent (SE) ≤ -5.0 diopters were reviewed. Exclusion criteria were follow-up <1 year; anisometropia > 3.0D; astigmatism > 3.0D and any systemic or ocular diseases associated with high myopia. Data was collected at presentation and every follow-up examination.

RESULTS Nineteen patients (38 eyes) were found eligible (10 boys, 52.6%). Mean age at presentation and follow-up was 2.6 ± 1.2 and 6.3 ± 1.6 years, respectively. Myopia increased between presentation and the end of follow-up [-8.4D (IQR -10.3, -6.4) vs. -9.5D (IQR -12.5, -7.5), respectively, p = 0.003]. The median was -0.6D (IQR -3.0, 0.5). There was a negative correlation between the SE at presentation and the amount of progression during follow-up (p = 0.01, rs = -0.536). There was a trend toward a higher increase in myopia between 9-12 vs. 2-5 years of age (p = 0.08). Mean best corrected visual acuity (BCVA) at the end of follow-up was 6/7.5. None of the patients had BCVA worse than 6/12 in both eyes. Three patients (15.8%) had BCVA worse than 6/12 in only one eye. Nine patients (47.4%) had strabismus. No patient developed other complications secondary to high myopia.

CONCLUSION IIOHM tends to remain stable in at least the first decade of life with good visual prognosis. Attention should be given to amblyopia, strabismus and larger refractive changes toward the second decade of life.