Cataract Surgery In Children Research Articles

Development of a prognostic model for predicting long-term visual acuity after cataract surgery in children with bilateral congenital cataracts: a single centre retrospective, observational study

BackgroundTo evaluate factors influencing best corrected visual acuity (BCVA) in paediatric patients with bilateral congenital cataracts (CC) after cataract extraction and intraocular lens (IOL) implantation, as well as develop a robust model for predicting long-term visual acuity.MethodsThis retrospective study followed 194 paediatric patients with bilateral CC from January 2008 to December 2021. The endpoint event was defined as a final BCVA < 0.22 Log MAR at the last follow-up, which indicated good outcome. The probability of reaching this endpoint event was modelled using Cox proportional hazards regression analysis and internally validated through 200 iteration of 5-fold cross-validation.ResultsA prognostic model for long-term visual acuity in bilateral CC after surgical treatment was established as follows: ln h(t) = −0.009 × “age at cataract extraction” − 0.015 × “age at IOL implantation” − 2.934 × “without nystagmus at last follow − up” + ln h0(0), in which h0(t) represents the baseline risk equation that can be any non-negative equation for time (t); h(t) represents the probability of the endpoint event occurring at time (t) without any endpoint event occurring before it. The model was visualized using a nomogram and contour plot to facilitate clinical practice. The model demonstrated reasonably accurate discrimination with an area under the receiver operating characteristic curve of 0.712 (95% confidence interval [CI]: 0.589–0.835) and a C-index of 0.797 (95% CI: 0.683–0.911). According to the model, children with bilateral CC had a higher likelihood of achieving a good outcome (BCVA < 0.22 Log MAR) if they underwent cataract extraction before the age of six months (hazard ratio [HR] 1.80, 95% CI: 0.92–3.70), received IOL implantation before the age of thirty-one months (HR 3.70, 95% CI: 1.77–7.80), and presented without nystagmus during their last follow-up visit (HR 11.20, 95% CI: 3.96–31.80).ConclusionsThis long-term visual acuity prognostic model demonstrates adequate performance for individualized prediction and assists in clinical decision-making. The risk stratification index guides optimal timing for surgery.

Evaluation of postoperative outcomes after cataract surgery in patients with Juvenile Idiopathic Arthritis-Associated Uveitis.

To evaluate the postoperative outcomes of cataract surgery and intraocular lens (IOL) implantation on visual outcomes and complications in pediatric patients with Juvenile Idiopathic Arthritis-Associated Uveitis. This study included 25 patients (30 eyes) with uveitis and cataracts who underwent cataract surgery. The study was conducted as a retrospective study. Patients were divided into two groups based on their preoperative treatment: those who received immunomodulatory therapy (IMT) along with systemic corticosteroids and those who received IMT in combination with a biologic therapy. Best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), macular volume (MV), and postoperative complications were assessed at various time points up to 12 months. All surgeries were performed by a single surgeon. Significant improvement in BCVA were observed postoperatively in both study groups, with approximately 80% of eyes showing improvement. Mean BCVA improved from 0.89 ± 0.63 to 0.37 ± 0.33 in group 1and from 0.82 ± 0.68 to 0.35 ± 0.31 in group 2 after 12 months. Postoperatively, there was a decrease in mean IOP, with no significant variance observed between the two groups. Complications were observed in 73% of cases, including posterior capsular opacification (PCO), secondary glaucoma, and macular edema (ME), but did not significantly differ between groups. Cataract surgery in children with uveitis associated with JIA presents significant challenges due to the risk of postoperative complications, even with adequate preoperative and postoperative care. The similar improvement in BCVA observed in both groups suggests that different systemic therapies were sufficient for satisfactory control of inflammation before and after surgery.

Bilateral cataract surgery in children: immediate sequential versus delayed sequential surgery

PurposeTo compare ocular and anesthesia-related complications in a cohort of patients having undergone either delayed sequential bilateral cataract surgery (DSBCS) or immediate sequential bilateral cataract surgery (ISBCS). MethodsThe medical records of children who underwent bilateral cataract surgery at our institution between 2012 and 2021were reviewed retrospectively. Included patients were 0-24 months of age, aphakic, and followed for at least 1 year after surgery. ResultsA total of 56 children were included: 23 underwent ISBCS; 33, DSBCS. Mean age at surgery was 2.6 ± 2.5 months for ISBCS patients and 2.8 ± 3.0 months for DSBCS patients (P = 0.752). Association with systemic diseases was more common in the ISBCS group. The mean anesthesia time per child was shorter in the ISBCS group (P < 0.001), although the mean total procedure time was similar in both groups. The rate of intraoperative anesthesia-related complications and intraocular complications was similar in both groups. There were no cases of endophthalmitis. The mean number of additional surgical interventions per child and the mean number of follow-up visits within 1 year were similar between groups. Children in the ISBCS group required fewer nights of hospital admission (P < 0.001). ConclusionsISBCS in children in this series did not lead to an increased incidence of ocular or anesthesia-related complications compared with DSBCS. ISBCS avoids repeated anesthesia and shortens the total time that the child is under anesthesia.

Influence of intraocular inflammatory cytokine levels on postoperative complications in congenital cataract surgery.

Posterior capsular opacification (PCO) accounts for the most significant and most challenging complication after successful cataract surgery in children. Our study aimed to investigate the levels of cytokines in the aqueous humor of children afflicted with congenital cataracts and their association with PCO. This was an observational study conducted at a tertiary referral center in India. Consecutive children aged less than 5 years with unilateral/bilateral isolated idiopathic congenital cataracts and planned for cataract extraction with intraocular lens implantation were included. During cataract surgery, 100-500 μl of aqueous samples were collected and the levels of inflammatory cytokines were quantified in the aqueous humor. An analysis of 28 samples was done. The mean age of the patients was 16.7 ± 0.4 months (range 3-60 months) with a mean follow-up 14.2 ± 2.3 months. On binary logistic regression, the level of MCP-1 was significantly related to the development of PCO at 1 year (P = 0.0072). Levels of IL-6 and IL-8 were not associated with the development of PCO (P = 0.05 and P = 0.07, respectively). Inflammatory markers like IL-6 and IL-8 were raised in children with pediatric cataracts in our study. Chronic high levels of MCP-1-induced fibrosis may be associated with PCO.

Первичный задний капсулорексис: исторические аспекты и современное состояние вопроса

Abstract Primary posterior capsulorexis: historical aspects and the current state of the issue E.V. Egorova, A.O. Direev, S. Fyodorov Eye Microsurgery Federal State Institution, Novosibirsk Branch, Novosibirsk, Russian Federation Research Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation Purpose. The paper analyzes the data of modern literature (published from 2008 to 2023) on the history and technique of primary posterior capsulorexis (PPC). The fields of application, variations, effectiveness and safety of the procedure are considered. Material and methods. A search for research on the subject of work from 2008 to 2023 was carried out. The search was carried out using Google Academy electronic databases (https://scholar.google.ru/), PubMed (https://www.ncbi.nlm. nih.gov/pubmed/), eLIBRARY.ru (https://www.elibrary.ru/) and foreign and domestic journals devoted to ophthalmology. Results. An analysis of the literature has shown that performing PPC provides high visual results both in comparison with standard cataract surgery and in the case of primary fibrosis of the posterior capsule. The key points of the PPC method are: intact anterior hyaloid membrane, continuous tear-resistant edge of capsulorexis and its size, which allows the preserved part of the PC to provide adequate support for the IOL and form a circular capsule barrier along the edge of its optical part. However, some studies have shown the possibility of partial or complete «closure» of the capsulorexis area by proliferating epithelial cells of the lens (ECL) in adult patients. In pediatric practice, it is well known that posterior hyaloid membrane (PHM) can act as a matrix for the migration of ECL, and the frequency of opacity of the optical axis after PPC reaches 60%. Therefore, in a number of clinics, the standard algorithm for cataract surgery in children includes not only PPC, but also anterior vitrectomy, although this complex approach is not always effective. As a solution to the problem of opacity of the optical axis after PPC, the technique of «capturing the optics» of the IOL was proposed, which permanently eliminates the opacity of the optical axis behind the IOL and significantly reduces fibrosis, especially in combination with polishing the anterior capsule. Conclusion. A large number of studies analyzing the clinical results of the PPC method, performed over several decades with various types of IOLs, leaves no doubt that performing posterior capsulorexis is a well-controlled method that significantly reduces the frequency of secondary cataracts, adding a «second line of defense» without reducing the barrier effect along the optical edge. Key words: anterior hyaloid membrane, Berger’s space, continuous curvilinear capsulorhexis, posterior optic capture

Intraoperative challenges and outcomes of pediatric cataract surgery following glaucoma filtering surgery.

To analyze the intraoperative challenges of cataract surgery in children, following glaucoma filtering surgery. This was a retrospective study to analyze intra-op challenges and outcomes of pediatric cataract surgery in post-glaucoma filtration surgery eyes, between January 2007 and December 2019. We included 20 eyes of 16 children. The most common glaucoma surgery performed was trabeculectomy and trabeculotomy (14 eyes). The median age at the time of cataract surgery was 74.5months. The most common cataract surgery performed was lens aspiration with posterior chamber intraocular lens implantation (LA + PCIOL) (9/20). The most common intraoperative challenge faced was difficulty in capsulorrhexis (ten eyes), followed by extension of primary posterior capsulotomy (six eyes). At the final follow up eight eyes had improvement in visual acuity, five eyes had stable visual acuity and five eyes had a drop in visual acuity. In 12/20 eyes IOL was implanted, nine eyes in-the-bag and three eyes had in ciliary sulcus. None of the IOLs in the bag had decentration of IOL. The median postoperative IOP (p = 0.12) and median number of postoperative AGM (p = 0.13) at 2years remained stable compared to the preoperative values. The IOP remained well controlled in 4 eyes without anti-glaucoma medications and in 14 eyes with anti-glaucoma medications and none needed additional surgery for IOP control. Two eyes developed retinal detachment postoperatively. Cataract surgery in pediatric eyes with prior glaucoma surgeries, have challenges with capsulorrhexis and IOL stability. The visual outcomes were reasonably good so was the IOP control.

Visual Results Following Surgery for Unilateral Congenital Cataract at a Tertiary Public Hospital in Maharashtra

Purpose: This study aimed to assess the visual outcomes of unilateral congenital cataract surgery in children.  Methods: A total of 204 eyes from 204 children, aged 2 to 12 months, undergoing unilateral congenital cataract surgery between December 2022 and March 2024, were included. The study analyzed data from a three-year follow-up and used chi-square tests to assess the relationship between visual outcomes and the age at surgery, considering P &lt; 0.05 as statistically significant.  Results: Of 204 eyes, 64 (31.4%) underwent surgery at 2-3 months and 140 (68.6%) at 3-12 months. Visual acuity was measured postoperatively, revealing significantly poorer outcomes in children aged 3 months or older (P &lt; 0.001) compared to those aged 2-3 months.  Conclusions: It is essential to detect and treat congenital cataracts early, followed by long-term postoperative rehabilitation, to improve visual outcomes in affected children, particularly in cases of unilateral cataract, which are more prone to developing amblyopia.

Cataract surgery outcomes in children and adolescents with type 1 diabetes mellitus

PurposeTo report the outcomes of cataract surgery in children and adolescents with type 1diabetes mellitus. MethodsThe medical records of all pediatric patients (<18 years of age) with a diagnosis of type 1 diabetes mellitus who had undergone surgery for cataract between January 2000 and December 2019 at a tertiary care center were reviewed retrospectively. ResultsA total of 27 eyes of 15 patients who met the inclusion criteria were included. Median age at cataract surgery was 13 (IQR, 9.5-16) years, and median follow-up was 3.8 (IQR, 1.25-7.2) years, with 11 eyes followed for more than 5 years. Visual acuity improved from a median preoperative value of 0.8 (IQR, 0.55-1.3) logMAR to 0.15 (IQR, 0-0.45) logMAR at final follow-up. Posterior capsular visual axis opacification in 40.7% and diabetic retinopathy in 14.8% were the common complications requiring additional intervention, including laser capsulotomy and panretinal photocoagulation, respectively. ConclusionsCataract surgery in children and adolescents with type 1 diabetes leads to improvement in visual acuity. Proliferative diabetic retinopathy can lead to poor visual outcomes in these children. Visual axis opacification occurs at similar rates with or without primary posterior capsulorhexis.

Observation on the tilt and decentration of multifocal intraocular lens with optic capture in Berger space for pediatric cataract.

This study aimed to observe the tilt and decentration of multifocal intraocular lens (IOL) with optic capture in Berger space within 2 years after pediatric cataract surgery. This is a prospective observational study. The implantation of multifocal IOL (Tecnis ZMB00) with optic capture in Berger space was performed on 33 patients (48 eyes) with pediatric cataract at Qingdao Eye Hospital. Tilt and decentration of IOL was measured using Scheimpflug system (Pentacam) at 1month and 2years postoperatively. All the multifocal IOLs were successfully implanted in Berger space with optic capture and no visually significant complications were detected during the follow-up. The mean tilt of IOLs was 2.779° ± 0.950° in the vertical plane and 2.399° ± 0.898° in the horizontal plane at 1month postoperatively, and the mean length of the decentration was 0.207 ± 0.081mm in vertical plane and 0.211 ± 0.090mm in the horizontal plane. Compared with 1month after surgery, the angle of tilt decreased by a mean of 0.192° and decentration increased by a mean of 0.014mm at the vertical meridian at 2 years postoperatively (P = 0.37 and P = 0.27, respectively), meanwhile, tilt increased by 0.265° and decentration increased by 0.012mm at the horizontal meridian (P = 0.11 and P = 0.22, respectively). The follow-up results suggest the tilt and decentration of multifocal IOL implantation with optic capture in Berger space remain stable in an acceptable range within 2years after cataract surgery in children above the age of 5. The study was approved by the Ethics Committee of Qingdao Eye Hospital, and registered on Chinese Clinical Trial Registry (ChiCTR identifier: 1900023155).

Corneal astigmatism induced by scleral small incision versus corneal tunnel incision in children after cataract surgery

Background The amount of postoperative astigmatism is an important factor in the development of amblyopia in children. Early postoperative astigmatism is of concern since amblyopia treatment is usually initiated as soon as possible after cataract surgery, and precise optical correction of astigmatism is needed to maximize visual improvement. Small-incision cataract surgery is preferred by some pediatric ophthalmologists, as it reduces corneal scarring and this reduces the incidence of irregular astigmatism. Also, it is very useful in cases with micro cornea and cases with low endothelial count. However, it has many disadvantages such as increased risk of bleeding, slower visual recovery, hyphemia from scleral vessels, and postoperative surgically induced astigmatism. Aim To assess corneal astigmatism induced by scleral tunnel small incision versus corneal tunnel incision after cataract surgery in children. Patients and methods The study was a prospective study and included 30 eyes of 30 children with cataract from the outpatient clinic of the ophthalmology department of Tanta University in the period between December 2021 to July 2022. Results There was an insignificant difference between the small incision and corneal tunnel incision as regard K1 and K2 prereadings, after 2 weeks, after 6 weeks, and after 3 months of readings. Conclusion We think that both corneal tunnel and scleral tunnel are stigmatically neutral in pediatric cataract surgery.

Cataract surgery in children using intracameral mydriatic.

To study the pupil dynamics with premixed intracameral anesthetic mydriatic combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) in pediatric cataract surgery. Consecutive children aged ≤12 years planned for cataract surgery were recruited. A commercially available premixed combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) was injected at the beginning of surgery without any topical/infusion drugs for mydriasis. Pupil sizes at various points of surgery were studied. We recruited 75 patients with a mean age of 24.3 ± 33.4 months (range: 1 month-11 years). Adequate mydriasis with a single injection was achieved in 93.5% (n = 73 eyes of 70 patients) without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.8 ± 0.79 to 6.1 ± 1.4 mm after injection (mean change of 4.2 ± 1.25 mm from baseline). The mean variability in pupillary diameter was 0.73 ± 1.3 mm. In five eyes, good dilatation was not possible even after repeat injection. Fixed-dose premixed intracameral injection is effective in pupil dilatation. It alleviates the need for any topical dilators or additional intraoperative supplementation for pediatric cataract surgery.

The comparison of corneal densitometry in cases with glaucoma following childhood cataract surgery and juvenile glaucoma

PurposeTo compare the corneal densitometry (CD) in pediatric cases with glaucoma following childhood cataract surgery and juvenile open-angle glaucoma (JOAG).MethodsThis prospective comparative study involved 13 eyes with JOAG, 12 eyes with pseudophakic glaucoma, 13 eyes with aphakic glaucoma, and 15 control subjects. Pentacam HR Scheimpflug corneal topography was employed to evaluate corneal thickness (CCT) and CD values.ResultsThe mean intraocular pressure (IOP) and CCT were significantly higher in aphakic glaucoma cases than the other groups (p = 0.001). In aphakic eyes, the mean CD values were higher in most of the anterior, center, and posterior layers of 0–2 mm, 2–6 mm, 6–10 mm, and total zones (p < 0.001 for all). In pseudophakic eyes, the mean CD values were statistically similar with that of aphakic eyes and higher than that of JOAG and control eyes in all layers of 0–2 mm zone and in anterior layer of 10–12 mm and anterior and total layers of 2–6 mm zones (p < 0.05 for all). The CD values demonstrated significant correlations with CCT values in both aphakic and pseudophakic eyes. However, a significant correlation of CD values with IOP was only demonstrated in aphakic eyes (p = 0.01 for all).ConclusionThe probable effects of childhood cataract surgery especially aphakia might cause corneal backscatter of light and increased CD in all layers in all zones of the cornea. Increased CD values and its correlation with CCT and IOP in aphakic glaucoma eyes may be of importance in clinical management.

Outcome of cataract surgery in children with presumed trematode-induced granulomatous anterior uveitis

PurposeTo examine the 6-month visual outcomes and complications following cataract surgery in patients with persumed trematode induced granulomatous anterior uveitis.SettingAssiut university hospital, Assiut, Egypt.DesignThis is a retrospective non comparative case series study.MethodsPatients presenting with significant cataract secondary to uveitis caused by trematode induced anterior chamber granuloma were included in this study.Cases with active anterior uveitis, within the last 3 months preceding surgery, and those with a history of trauma, were excluded from this study.Data collected included demographic characteristics, history of the condition including when uveitis started, treatment received and history of other health conditions that may be relevant to uveitis.Complete opthalmologic examination including assessment of best corrected visual acuity (BCVA) and OCT macula, if possible, were done. These was repeated 1 week, 1 month, 3 months and 6 months after surgery. Specular microscopy was performed preoperatively and 3 months after surgery. Patients underwent cataract surgery with posterior chamber intra ocular lens and statistical analysis was performed to compare preoperative and postoperative BCVA and corneal endothelial cell counts. Postoperative complications were recorded.ResultsFive eyes of 5 patients were included in the study. All study eyes showed improvement in the post-operative visual acuity.A statistically significant improvement was observed in VA in the sixth postoperative month compared to the baseline measurements (p = 0.004). No statistically significant difference was observed between the preoperative and postoperative endothelial cell counts (p = 0.696). Cystoid macular edema did not occur as a postoperative complication.ConclusionVisual outcomes of cataract surgery in eyes with persumed trematode induced granulametous anterior uveitis are favorable. No sight threatening complication was observed in our series.

The Effects of Cataract Surgery on Children's Vision: A Systematic Review.

Five-fifths of all incidents of blindness in Saudi Arabia may be attributed to cataracts. Cataracts are the second major cause of blindness, responsible for 35.5% of cases. Therefore, the purpose of the research was to measure the visual acuity improvement after cataract surgery in children. This systematic review followed PRISMA guidelines for reporting systematic reviews. All procedures followed the recommendations of the Cochrane handbook. Studies of varying study designs, both published and unpublished, are included. Retrospective studies with outcomes of pediatric cataract surgery were identified from various databases. After an initial screening, 108 out of 167 items were deemed unsuitable for publication. There were 59 full-text papers assessed for inclusion, and only seven matched the criteria. All the articles included were of a very high standard. Both the duration of therapy and the target population varied widely between the studies. The results indicated that the majority of childhood cataracts are hereditary. Primary posterior capsulectomy and anterior vitrectomy combined with cataract extraction and intra-ocular lens implantation is the treatment of choice for pediatric cataracts. It is recommended that surgery be performed in a properly equipped facility staffed by trained, cooperative personnel and that different procedures be used to enhance post-operative follow-up.

Postoperative glaucoma following cataract surgery in children

Aims/Purpose: The aim of this work is to investigate the prevalence of secondary glaucoma and its associated risk factors in children undergoing congenital cataract surgery.Methods: A retrospective study was performed, spread over 8 years, from January 2014 to October 2021, in the paediatric ophthalmology department at the August 20 Hospital in Casablanca. It includes 516 eyes of children operated on for congenital cataract and aged under 16.Results: Development of glaucoma was defined as IOP &gt; 22 mmHg, increased corneal diameter, increased cup to disc ratio, and reduced anterior chamber depth. We mainly evaluated the following risk factors: age at the time of surgery, unilateral or bilateral cataract, presence of microcornea, performance of posterior capsulotomy with anterior vitrectomy and primary implantation.Conclusions: Congenital cataract surgery at an early age increases the risk of developing glaucoma, whether the eye is aphakic or pseudophakic. The management of secondary glaucoma is heavy, the visual prognosis is compromised, hence the interest of long‐term follow‐up.

Glaucoma Following Cataract Surgery in Children—Finally, a Clue

Glaucoma Following Cataract Surgery in Children—Finally, a Clue

Prevalence of Glaucoma Following Paediatric Cataract Surgery in an Australian Tertiary Referral Centre.

Secondary glaucoma following childhood cataract surgery remains the most common complication in the paediatric population. This study aimed to determine the incidence, time to progression and risk factors associated with the development of secondary glaucoma following childhood cataract surgery in a paediatric population. Outcome measures were the detection of secondary glaucoma, postoperative time frame to development of glaucoma and risk factors in its development. A retrospective case series was conducted between 2003 and 2017 at a tertiary children's hospital in Sydney. The patient population included those 16 years or less of age who underwent congenital cataract extraction, with or without an intraocular lens implantation and who had been followed up for a minimum of six months following surgery. Patients were excluded if they had cataract aetiology other than congenital idiopathic cataract. Multivariate Cox Regression analysis was used to determine relevant risk factors. A total of 320 eyes in 216 patients were included in the study. Secondary glaucoma developed in 11.9% of eyes. In those that developed secondary glaucoma, the average time to onset from surgery was 3.2 years (median 2.75 years). The mean age of diagnosis of secondary glaucoma was 4.58 years (median 3.5 years, range 2.5 months to 13.23 years). Microcornea was the only adverse characteristic significantly associated with an increased risk of secondary glaucoma (HR 6.30, p 0.003). Despite modern surgical techniques, glaucoma remains a significant long-term sequela in children following cataract surgery.

Outcomes of cataract surgery in children who present with cataract at uveitis diagnosis

To describe the clinical and demographic characteristics of patients presenting with cataract at uveitis diagnosis treated at a single institution between 2005 and 2019 and to analyze postoperative outcomes following cataract surgery. We retrospectively reviewed the medical records of children (<18 years of age) diagnosed with cataract at their initial uveitis presentation who subsequently underwent cataract extraction. Outcome measures were best-corrected visual acuity, number of uveitis flare-ups (cells ≥1+), and postoperative complications. A total of 14 children (17 eyes) were included. Mean patient age was 7.2 ± 3.9 years. Methotrexate was initiated preoperatively in 11 patients; adalimumab, in 3. Primary intraocular lens was implanted in 4 eyes. Best-corrected visual acuity improved from a mean of 0.90 ± 0.40 logMAR preoperatively to 0.50 ± 0.35 logMAR at 1 year and 0.57 ± 0.40 logMAR at mean of 6.3 ± 3.4 years postoperatively. Four eyes (24%) had a single episode of uveitis flare-up during the first postoperative year. Macular and/or disk edema was discovered in 6 eyes following cataract removal. Only 3 eyes (18%) had ocular hypertension in the first year, but glaucoma developed in subsequent years in 7 eyes (41%), 5 of which required surgery. In our study cohort, surgery for preexisting cataract at uveitis diagnosis resulted in improved visual acuity. Postoperative uveitis flare-ups were relatively uncommon, occurring in 4 of 17 eyes. Glaucoma was the main long-term complication.

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

Glaucoma can develop following cataract removal in children. To assess the cumulative incidence of glaucoma-related adverse events (defined as glaucoma or glaucoma suspect) and factors associated with risk of these adverse events in the first 5 years after lensectomy prior to 13 years of age. This cohort study used longitudinal registry data collected at enrollment and annually for 5 years from 45 institutional and 16 community sites. Participants were children aged 12 years or younger with at least 1 office visit after lensectomy from June 2012 to July 2015. Data were analyzed from February through December 2022. Usual clinical care after lensectomy. The main outcomes were cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of these adverse events. The study included 810 children (1049 eyes); 443 eyes of 321 children (55% female; mean [SD] age, 0.89 [1.97] years) were aphakic after lensectomy, and 606 eyes of 489 children (53% male; mean [SD] age, 5.65 [3.32] years) were pseudophakic. The 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% CI, 25%-34%) in 443 eyes with aphakia and 7% (95% CI, 5%-9%) in 606 eyes with pseudophakia; 7% (95% CI, 5%-10%) of aphakic eyes and 3% (95% CI, 2%-5%) of pseudophakic eyes were diagnosed as glaucoma suspect. Among aphakic eyes, a higher risk for glaucoma-related adverse events was associated with 4 of 8 factors, including age less than 3 months (vs ≥3 months: adjusted hazard ratio [aHR], 2.88; 99% CI, 1.57-5.23), abnormal anterior segment (vs normal: aHR, 2.88; 99% CI, 1.56-5.30), intraoperative complications at time of lensectomy (vs none; aHR, 2.25; 99% CI, 1.04-4.87), and bilaterality (vs unilaterality: aHR, 1.88; 99% CI, 1.02-3.48). Neither of the 2 factors evaluated for pseudophakic eyes, laterality and anterior vitrectomy, were associated with risk of glaucoma-related adverse events. In this cohort study, glaucoma-related adverse events were common after cataract surgery in children; age less than 3 months at surgery was associated with elevated risk of the adverse events in aphakic eyes. Children with pseudophakia, who were older at surgery, less frequently developed a glaucoma-related adverse event within 5 years of lensectomy. The findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age.

This issue of ACTA

This issue of ACTA