PURPOSE: The purpose of this study was to compare relative peripheral refraction (RPR) and axial growth in Chinese pediatric patients with cataract who underwent multifocal or monofocal intraocular lens (IOL) implantation. METHODS: Pediatric patients with cataract aged 3 to 6 years who underwent IOL implantation from 2020 to 2021 were enrolled in this study. The patients received multifocal or monofocal IOL implantations with optic capture in Berger's space. The axial length (AL) was measured with a Zeiss IOL Master 700, and autorefraction at the horizontal retina within 30 degrees eccentricities was recorded with a Grand Seiko WAM-5500 autorefractor. The RPR was calculated by subtracting the central refraction from the peripheral refraction. The axial growth rate was calculated as the change in the AL divided by the number of follow-up years. RESULTS: Twenty-six children (38 eyes) implanted with multifocal IOLs and 19 children (30 eyes) implanted with monofocal IOLs completed the study. No significant differences were observed in preoperative characteristics between the two groups (P >
0.05). The generalized estimating equation (GEE) model revealed that the axial growth rate was significantly associated with the IOL type (P = 0.049) after adjusting for surgical age and follow-up intervals, with multifocal IOL eyes showing lower annual growth rate than monofocal IOL eyes. Additionally, compared with monofocal IOL eyes, multifocal IOL eyes exhibited greater peripheral myopic defocus at 20 degrees and 30 degrees on the temporal retina (P <
0.001 and P = 0.005, respectively). The GEE model also revealed a positive correlation between the annual axial growth rate and the 20 degrees temporal retina RPR (P = 0.018). CONCLUSIONS: Chinese pediatric patients with cataract who underwent multifocal IOL implantation exhibited less axial growth, potentially caused by greater peripheral myopic defocus.