• Glaucoma, Pediatric Ophth/Strabismus

    Review of: Visual acuity and ophthalmic outcomes 5 years after cataract surgery among children younger than 13 years

    Repka M, Dean T, Kraker R, et al. JAMA Ophthalmology, in press

    The long-term ophthalmic outcomes of children who have had cataract surgery have not been extensively studied. To that end, investigators looked at visual outcomes, complications, and the need for additional eye operations in the first 5 years following pediatric cataract surgery.

    Study design

    This was a multinational, prospective cohort study of 994 pediatric patients (1268 eyes) aged ≤13 years undergoing bilateral or unilateral lensectomy whose information was entered in the Pediatric Eye Disease Investigator Group (PEDIG) registry. Fifty-nine percent of eyes received an intraocular lens (IOL) implantation. A Cox proportional hazards regression model was used to estimate the 5-year cumulative incidence of glaucoma or glaucoma suspect, collectively termed “glaucoma-related adverse event.”

    Outcomes

    In general, 5 years after cataract surgery the children who underwent a bilateral procedure with or without an IOL showed better visual acuity outcomes than the children who underwent a unilateral procedure. The 5-year cumulative incidence of glaucoma-related adverse events was highest in children with either bilateral aphakia (46%) or unilateral aphakia (25%). Myopic shifts were greater in aphakic patients than in pseudophakic patients; the latter group had a higher incidence of needing surgery to clear the visual axis.

    Limitations

    Only 66% of the 994 children in the registry completed the 5-year follow-up visit. In addition, enrollment of patients was at the discretion of the clinicians, who may have excluded patients with complex surgeries or complications.

    Clinical significance

    Children who undergo cataract surgery should be monitored for glaucoma development. There is less myopic shift in pseudophakic patients, which should be considered when selecting an implant.