Visual Acuity and Ophthalmic Outcomes 5 Years After Cataract Surgery Among Children Younger Than 13 Years

Abstract

IMPORTANCECataract is an important cause of visual impairment in children. Data from a large pediatric cataract surgery registry can provide real-world estimates of visual outcomes and the 5-year cumulative incidence of adverse events. OBJECTIVE To assess visual acuity (VA), incidence of complications and additional eye operations, and refractive error outcomes 5 years after pediatric lensectomy among children younger than 13 years. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study used data from the Pediatric Eye Disease Investigator Group clinical research registry. From June 2012 to July 2015, 61 eye care practices in the US, Canada, and the UK enrolled children from birth to less than 13 years of age who had undergone lensectomy for any reason during the preceding 45 days. Data were collected from medical record reviews annually thereafter for 5 years until September 28, 2020. EXPOSURES Lensectomy with or without implantation of an intraocular lens (IOL).MAIN OUTCOMES AND MEASURES Best-corrected VA and refractive error were measured from 4 to 6 years after the initial lensectomy. Cox proportional hazards regression was used to assess the 5-year incidence of glaucoma or glaucoma suspect and additional eye operations. Factors were evaluated separately for unilateral and bilateral aphakia and pseudophakia.RESULTS A total of 994 children (1268 eyes) undergoing bilateral or unilateral lensectomy were included (504 [51%] male; median age, 3.6 years; range, 2 weeks to 12.9 years). Five years after the initial lensectomy, the median VA among 701 eyes with available VA data (55%) was 20/63 (range, 20/40 to 20/100) in 182 of 316 bilateral aphakic eyes (58%), 20/32 (range, 20/25 to 20/50) in 209 of 386 bilateral pseudophakic eyes (54%), 20/200 (range, 20/50 to 20/618) in 124 of 202 unilateral aphakic eyes (61%), and 20/65 (range, 20/32 to 20/230) in 186 of 364 unilateral pseudophakic eyes (51%). The 5-year cumulative incidence of glaucoma or glaucoma suspect was 46% (95% CI, 28%-59%) in participants with bilateral aphakia, 7% (95% CI, 1%-12%) in those with bilateral pseudophakia, 25% (95% CI, 15%-34%) in those with unilateral aphakia, and 17% (95% CI, 5%-28%) in those with unilateral pseudophakia. The most common additional eye surgery was clearing the visual axis, with a 5-year cumulative incidence of 13% (95% CI, 8%-17%) in participants with bilateral aphakia, 33% (95% CI, 26%-39%) in those with bilateral pseudophakia, 11% (95% CI, 6%-15%) in those with unilateral aphakia, and 34% (95% CI, 28%-39%) in those with unilateral pseudophakia. The median 5-year change in spherical equivalent refractive error was −8.38 D (IQR, −11.38 D to −2.75 D) among 89 bilateral aphakic eyes, −1.63 D (IQR, −3.13 D to −0.25 D) among 130 bilateral pseudophakic eyes, −10.75 D (IQR, −20.50 D to −4.50 D) among 43 unilateral aphakic eyes, and −1.94 D (IQR, −3.25 D to −0.69 D) among 112 unilateral pseudophakic eyes. CONCLUSIONS AND RELEVANCEIn this cohort study, development of glaucoma or glaucoma suspect was common in children 5 ye...

Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy

“…The PECARE registry (288 eyes with follow-up) identified an increased risk of glaucoma associated with early surgery, with the majority of children with glaucoma having lensectomy prior to 3 months of age and 73% having a history of lensectomy in the first month of life. Of note, IATS, IoLunder2, and TAPS excluded certain high-risk eyes from enrollment or analysis and studied eyes of younger children, whereas the PECARE and PEDIG cataract registries included cataract associated with a range of comorbidities, including microcornea, persistent fetal vasculature, and other ocular diseases. The first 3 months of life have also been identified as the highest risk period for development of glaucoma in retrospective case series .…”

“…Overall, 994 children (1382 eyes) aged 12 years or younger who had undergone unilateral or bilateral lensectomy during the preceding 45 days (between June 2012 and July 2015) were enrolled in the registry across 61 sites . Outcomes through 5 years of follow-up for the entire cohort are reported elsewhere . For this analysis of glaucoma-related adverse events, eyes with a preoperative diagnosis of glaucoma, glaucoma suspect, traumatic cataract, Lowe syndrome, or aniridia were excluded.…”

“…Bilateral surgery was defined as surgery in both eyes by the last completed annual data collection or by history of a lensectomy in the fellow eye prior to study enrollment. Glaucoma was defined as intraocular pressure (IOP) greater than 21 mm Hg and 1 of the following: abnormal corneal enlargement (≥11 mm), increased optic nerve cupping (≥0.2 increase in the horizontal cup-disc ratio from preoperative ratio), use of medication to reduce IOP, or glaucoma surgery . Glaucoma suspect was defined as an IOP greater than 21 mm Hg in the absence of a criterion for glaucoma.…”

Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract

“…Complications included visual axis opacification (VAO), surgery for VAO (Nd:YAG laser capsulotomy, anterior vitrectomy, and/or membranectomy), corneal calcification, retinal detachment, peripheral anterior synechiae, posterior synechiae, persistent intraocular inflammation, surgically induced iris abnormalities, and endophthalmitis. Other analyses of these patients have been described previously but have not reported the association of age at lensectomy or IOL location with the incidence of complications in primary pseudophakia.…”

“…Pediatric lensectomy with primary intraocular lens (IOL) placement can be associated with postoperative complications, but long-term data on their incidence are limited. The Pediatric Eye Disease Investigator Group (PEDIG) cataract registry provides a large data set of children older than 2 years with pseudophakia. Herein, we report the type and frequency of complications occurring through 5 years after primary IOL implantation and evaluate the potential association of age at surgery and method of IOL fixation (capsular bag vs sulcus) with clinical decision making.…”