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  • Pediatric Cataract Surgery: Five-Year Results

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, March 2022

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    Repka et al. assessed outcomes fol­lowing pediatric lensectomy among chil­dren younger than 13 years of age. They found that five years after surgery, age-normal visual acuity (VA) was uncom­mon and that the risk for glaucoma development had increased.

    For this prospective cohort study, the researchers used data from the Pediatric Eye Disease Investigator Group (PEDIG) clinical research reg­istry. BCVA and refractive error were measured from four to six years after the initial lensectomy. Cox proportion­al hazards regression was used to assess the five-year incidence of glaucoma or glaucoma suspect and additional eye operations. Factors were evaluated for four subgroups: unilateral aphakia (n = 202), bilateral aphakia (n = 316), unilateral pseudophakia (n = 364), and bilateral pseudophakia (n = 386).

    A total of 994 children (1,268 eyes) with a mean age of 3.6 years (range, 2 weeks to 12.9 years) were included in this analysis. Slightly more than half (504; 51%) were male. At five years, results were as follows:

    VA. Data on VA outcomes were available for 701 of the 1,268 eyes. The median VA was 20/64 (range, 20/40 to 20/100) in 182 bilateral aphakic eyes; 20/32 (range, 20/25 to 20/50) in 209 bilateral pseudophakic eyes; 20/200 (range, 20/50 to 20/618) in 124 uni­lateral aphakic eyes; and 20/65 (range, 20/32 to 20/230) in 186 unilateral pseudophakic eyes.

    Glaucoma or glaucoma suspect. The five-year cumulative incidence of glau­coma or glaucoma suspect ranged from 7% for those with bilateral pseudopha­kia to 46% for those with bilateral aphakia.

    Additional eye surgery. The most common additional eye surgery was clearing the visual axis, with a five-year cumulative incidence ranging from 7% of those with bilateral pseudophakia to 34% of those with unilateral pseudophakia.

    Refractive error. The median five-year change in spherical equivalent refractive error was –8.38 D among 89 bilateral aphakic eyes, –1.63 D among 130 bilateral pseudophakic eyes, –10.75 D among 43 unilateral aphakic eyes, and –1.94 D among 112 unilateral pseudophakic eyes.

    These results support frequent monitoring after pediatric cataract surgery, the researchers said. (Also see related commentary by Jeff Yunglam Hui, MB, ChB, MPH, in the same issue.)

    The original article can be found here.