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  • Pediatric lensectomy often associated with good visual acuity

    Cataract/Anterior Segment, Pediatric Ophth/Strabismus

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    This study described the visual outcomes and complications 1 year after pediatric cataract surgery.

    Study design

    Researchers prospectively followed 880 children (1,132 eyes) at 61 pediatric eye care practices. The children were younger than 13 years of age at the time that they underwent lensectomy in at least 1 eye, with or without IOL implantation. All children were followed up within 15 months of surgery. Lens surgery was bilateral in 362 children (41.1%) and unilateral in 518 children (58.9%). An IOL was implanted in 60.2% of eyes.

    Outcomes

    In this study, visual acuity in pseudophakic eyes ranged widely from 20/16 to less than 20/800, with 35.5% of patients achieving normal values for their age range. Vision of 20/50 or better was achieved in 82% of bilateral pseudophakic eyes and in 52% of unilateral pseudophakic eyes. In bilateral pseudophakic eyes, the average visual acuity was better with older age. Among aphakic eyes, 42.2% achieved age-normal values.

    Amblyopia was seen in 51% of children with the highest incidence (83.7%) in unilateral aphakic children and the lowest incidence (22%) in bilateral pseudophakic children. Elevated IOP was observed in 7.3% of the 889 eyes that had IOP data. New glaucoma-related adverse events occurred in 5.9% of eyes. Visual axis opacification occurred in 15.1% of eyes. An additional intraocular surgery was performed in 17% of eyes, most commonly for clearing the visual axis.

    Limitations

    Even though this study had a robust cohort, investigator discretion determined the surgical techniques and postoperative management. As a result, the data represent real-world experience rather than showing the outcomes of a particular protocol. Visual acuity was not reported using standardized measures due to the wide age range of patients.

    Clinical significance

    This study suggests that lensectomy is often associated with good visual acuity, though visual acuity in this study was lower than normal. The incidence of amblyopia in this cohort was very high (affecting 51% of children with lensectomy), underscoring the importance of adequate post-operative care and aggressive management of amblyopia. Management of visual axis obscuration was the most common contributor to a second surgery.