Unplanned returns to the operating room within three months of pediatric cataract-related intraocular surgery: indications and risk factors

Jackson, Colette M.; Bickford, Matthew W.; Trivedi, Rupal H.; Wilson, M. Edward

doi:10.1016/j.jaapos.2019.05.007

Cited by 3 publications

(27 citation statements)

References 4 publications

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“…Postoperative complications may be seen during the early postoperative period (e.g., wound leak, intraocular pressure (IOP) spike, corneal edema, anterior uveitis), after a few months but within a few years (posterior capsule opacification, glaucoma), or several years after cataract surgery (glaucoma, retinal detachment, high myopia). Indications, risk factors and the rate of an unanticipated return to the operating room within 3 months of pediatric cataract-related intraocular surgery has been reported recently [7]. The overall reoperation rate was 3.3% within 90 days after cataract surgery.…”

Section: Postoperative Complicationsmentioning

confidence: 95%

“…Factors that increased the risk for reoperation were a history of a traumatic cataract (relative risk 2.55) or age <1 year at the time of first surgery (relative risk 3.02). In the absence of these risk factors, the rate of reoperation during the first 90 days postoperative period was 1.1% [7]. The Toddler Aphakia & Pseudophakia Study (TAPS) recently reported outcomes of unilateral cataracts in infants and toddlers 7 to 24 months of age [8].…”

Section: Postoperative Complicationsmentioning

confidence: 99%

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Intraoperative and Postoperative Complications

Trivedi

Wilson

2021

Essentials of Pediatric Cataract Surgery

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Cataract surgery in children is more difficult and the rate of complications is higher when compared to adult surgery. The rate of intraoperative and postoperative complications is inversely proportional to the age at surgery. In addition to age, surgical technique can influence the rate of complications (e.g., primary intraocular lens implantation vs. aphakia). Higher intraoperative complications in children may be attributed to the common occurrence of an immature iris that results in poor pupil dilation. In addition, the eyes of young children are small and soft. Even small and well-constructed surgical wounds leak when not sutured securely. The anterior capsule in children is highly elastic and difficult to predictably tear into a circular and centered capsulorhexis. Scleral collapse and a formed, non-liquified, vitreous body create the upthrust commonly referred to as posterior vitreous pressure. Postoperative complications are also higher due to an intense inflammatory response and poor compliance to postoperative topical anti-inflammatory drops. The detection of postoperative complications can be challenging because of the difficulties encountered in performing detailed postoperative examinations in children, who may be uncooperative.

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Section: Postoperative Complicationsmentioning

confidence: 95%

Section: Postoperative Complicationsmentioning

confidence: 99%

Intraoperative and Postoperative Complications

Trivedi

Wilson

2021

Essentials of Pediatric Cataract Surgery

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“…Of these potentially relevant articles, 176 publications were excluded for various reasons, and 33 publications met the inclusion criteria and were included in this report. These comprised 3 RCTs [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] and 15 nonrandomized studies, [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] relevant to research questions 1, 2, 3, and 4. No economic evaluations relevant to research questions 5 and 6 were identified. There were 16 clinical publications and 1 methods publication (which was not included in the overall count) 77 that reported on the same RCT -the Infant Aphakia Treatment Study (IATS).…”

Section: Quantity Of Research Availablementioning

confidence: 99%

“…The RCTs were conducted in the US [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]77 and India. 60,61 The nonrandomized studies were conducted in the US, [63][64][65] Germany, 66 Ireland, 67,68 UK, 69 Latvia, 70 China, 71 India, [72][73][74] France, 75 Brazil, 62 and Korea. 76 There were multiple publications for the IATS, which were published in 2020, 46,50,53 2016, 55,56 2015, 52,59 2014, 45,49,58 2013, 54,57 2012, 51 2011, 47,48 and 2010.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…76 There were multiple publications for the IATS, which were published in 2020, 46,50,53 2016, 55,56 2015, 52,59 2014, 45,49,58 2013, 54,57 2012, 51 2011, 47,48 and 2010. 44 The years of publication for the remaining studies were 2021, 62 2020, 63,64,66,67,69,71 2019, 65 2018, 60 2017, 61,72,75 2016, 73 2014, 74,76 and 2010. 68 The studies were funded primarily by grants from organizations such as the National Eye Institute, [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]77 the American Society of Cataract and Refractive Surgery Foundation, 61 Mayo Clinic, 63 Research to Prevent Blindness, 64 National Institute for Health Research,…”

Section: Study Characteristicsmentioning

confidence: 99%

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Intraocular Lenses for Infants With Aphakia

Team¹

2022

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This systematic review examined intraocular lens implantation in patients aged 12 months or younger at the time of surgery compared with patients aged 12 months or younger with aphakia treated with contact lenses or glasses. It also examined intraocular lens implantation in patients aged 12 months or younger at the time of surgery (i.e., infants) compared with patients older than 12 months up to 12 years of age at the time of surgery (i.e., children). In total, 18 studies (3 randomized controlled trials and 15 nonrandomized studies) were identified that answered the clinical questions relevant to this review. No relevant studies were identified to inform the cost-effectiveness questions. Visual outcomes (i.e., visual acuity) did not seem to differ between patients aged 12 months or younger at the time of surgery who received intraocular lens implantation and in patients with aphakia treated with contact lenses or glasses. Parenting stress was higher in parents of infants who received intraocular lens implantation at 3 months after surgery compared with parents of infants who were treated with contact lenses; however, this difference was not maintained at 1 year after surgery. In 1 study that examined intraocular lens implantation at different ages, age did not appear to be a significant prognostic factor in poor visual outcomes (i.e., visual acuity defined as > 0.5 logMAR). Regarding safety, infants who underwent intraocular lens implantation experienced more frequent occurrences of complications, such as visual axis opacification, compared with infants with aphakia treated with contact lenses or glasses; therefore, more reoperations to remove the opacification were required. Many infants with aphakia who did not receive intraocular lens implantation eventually required the surgery when they got older. There were limited statistical comparisons available for safety outcomes for intraocular lens implantation in infants at different ages. Overall, the incidence in adverse events was similar between infants and children, except for the number of additional surgeries. In the identified literature, younger patients received more additional surgeries than older patients. The risk of bias in the included studies was high. There were many methodological concerns, including selection bias, reporting issues, statistical issues, and study designs with high risk of bias, such as retrospective cohort studies. Family input regarding patients’ and caregivers’ experiences included reports of stress related to the use of contact lenses and stress about outcomes of the cataract removal and/or intraocular lens implantation and the effect on the child, and emphasized timely treatment to ensure optimal development of the child.

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