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  • One-Year Outcomes for Children After Cataract Surgery

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, July 2019

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    Repka et al., for the Pediatric Eye Disease Investigator Group (PEDIG), evaluated outcomes in 880 children who underwent lensectomy for cataract surgery in at least one eye. Within the year following surgery, amblyopia occurred in just over half of the study population, and visual acuity (VA) was normal in roughly one-third. Although the rate of unexpected complications was low, subsequent surgery was need­ed in 17% of study eyes.

    This PEDIG study was conducted from June 2012 to July 2015; the chil­dren represented 61 pediatric eye care practices (57 in the United States, three in Canada, and one in the United King­dom). All participants were less than 13 years old at the time of lensectomy (with or without IOL implantation) and had follow-up within 15 months of the surgery. Main outcome measures were VA and the rates of amblyopia, confirmed glaucoma, suspected glauco­ma, and other intraocular surgery. The mean age at annual follow-up was 4.9 years. Of the 880 patients, 41.1% (n = 362) had bilateral surgery and 58.9% (n = 518) had unilateral surgery. Of the 1,132 study eyes, 60.2% (n = 654) received an IOL.

    According to follow-up data, 51% of participants (n = 449) experienced amblyopia. Among children age 3 or older, mean VA was 0.30 logMAR (~20/40) in 153 bilateral pseudophakic eyes, 0.49 logMAR (~20/63) in 141 unilateral pseudophakic eyes, 0.47 log­MAR (~20/63) in 21 bilateral aphakic eyes, and 0.61 logMAR (~20/80) in 17 unilateral aphakic eyes. Improvement in VA correlated with older age at sur­gery for eyes with bilateral or unilateral pseudophakia.

    A new diagnosis of glaucoma or sus­pected glaucoma was made for 6.3% of eyes that did not have glaucoma before lensectomy (67/1,064), 13.2% of eyes with bilateral aphakia (36/273), 7.9% of eyes with unilateral aphakia (14/178), 1.6% of eyes with bilateral pseudopha­kia (5/308), and 3.9% of eyes with unilateral pseudophakia (12/305). Subsequent intraocular surgery (most commonly for visual axis obscuration) was required for 17% of study eyes (189/1,132).

    The authors recommend frequent monitoring of pediatric patients in the year following lensectomy to detect visual axis clouding and changes in vision.

    The original article can be found here.