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Observational Study
. 2016 Dec;123(12):2462-2473.
doi: 10.1016/j.ophtha.2016.09.003. Epub 2016 Oct 18.

Cataract Surgery in Children from Birth to Less than 13 Years of Age: Baseline Characteristics of the Cohort

Michael X Repka  1 , Trevano W Dean  2 , Elizabeth L Lazar  2 , Kimberly G Yen  3 , Phoebe D Lenhart  4 , Sharon F Freedman  5 , Denise Hug  6 , Bahram Rahmani  7 , Serena X Wang  8 , Raymond T Kraker  2 , David K Wallace  5 ; Pediatric Eye Disease Investigator Group
Affiliations
Observational Study

Cataract Surgery in Children from Birth to Less than 13 Years of Age: Baseline Characteristics of the Cohort

Michael X Repka et al. Ophthalmology. 2016 Dec.

Abstract

Objective: To describe baseline characteristics, initial postoperative refractive errors, operative complications, and magnitude of the intraocular lens (IOL) prediction error for refractive outcome in children undergoing lensectomy largely in North America.

Design: Prospective registry study of children from birth to <13 years of age who underwent lensectomy for any reason within 45 days preceding enrollment.

Participants: Total of 1266 eyes of 994 children; 49% female and 59% white.

Methods: Measurement of refractive error, axial length, and complete ophthalmic examination.

Main outcome measures: Eye and systemic associated conditions, IOL style, refractive error, pseudophakic refraction prediction error, operative and perioperative complications.

Results: Mean age at first eligible lens surgery was 4.2 years; 337 (34%) were <1 year of age. Unilateral surgery was performed in 584 children (59%). Additional ocular abnormalities were noted in 301 eyes (24%). An IOL was placed in 35 of 460 eyes (8%) when surgery was performed before 1 year of age, in 70 of 90 eyes (78%) from 1 to <2 years of age, and in 645 of 716 eyes (90%) from 2 to <13 years of age. The odds of IOL implantation were greater in children ≥2 years of age than in those <2 years of age (odds ratio = 29.1; P < 0.001; 95% confidence interval: 19.6-43.3). Intraoperative complications were reported for 69 eyes (5%), with the most common being unplanned posterior capsule rupture in 14 eyes, 10 of which had an IOL placed. Prediction error of the implanted IOL was <1.00 diopter in 54% of eyes, but >2.00 diopters in 15% of eyes.

Conclusions: Lensectomy surgery was performed throughout childhood, with about two-thirds of cases performed after 1 year of age. Initial surgery seemed safe, with a low complication rate. IOL placement was nearly universal in children 2 years of age and older. The immediate postoperative refraction was within 1 diopter of the target for about one-half of eyes.

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Conflict of interest statement

No conflicting relationships exist for any author.

Figures

Figure 1
Figure 1
Distribution of Axial Length for Bilateral and Unilateral Cataract Surgery Stratified by Age at Surgery. Axial length increased with age, regardless of laterality of cataract surgery. The top and bottom of each box represents the 75th and 25th percentiles of the data, respectively. Group medians are represented by the horizontal line in each box and group means by filled circles. The bars extending above and below each box represent 1.5 times the interquartile range (difference between the 75th and 25th percentiles), or the maximum (or minimum) observed value within the range if not as extreme as the calculated value. The open circles represent statistical outliers.
Figure 2
Figure 2
Intraocular Lens (IOL) Implantation for Children with Unilateral Cataract Surgery Stratified by Age at Surgery. The percentage of IOL implantation increased with age in children undergoing unilateral surgery. Each column displays the number of eyes with cataract surgery within each age group. Columns are divided into two categories, representing the percentage of eyes within that age group that received IOL implant at the time of surgery (light grey) and those that did not (dark grey).
Figure 3
Figure 3
Intraocular Lens (IOL) Implantation for Children with Bilateral Cataract Surgery Stratified by Age at Surgery. The percentage of IOL implantation increased with age in children undergoing bilateral surgery. Each column displays the number of eyes with cataract surgery within each age group. Columns are divided into two categories, representing the percentage of eyes within that age group that received an IOL implant at the time of surgery (light grey) and those that did not (dark grey).
Figure 4
Figure 4
Distribution of Power of Implanted Intraocular Lenses (IOL). IOL power, ranging from +2.00 to +39.00 diopters, was reported for 744 eyes.
Figure 5
Figure 5
Distribution of Postoperative Refractive Error in Pseudophakic Eyes. Postoperative refractive error reported for 651 eyes with a mean of +1.36 D (range = −10.00 D to +14.50 D).
Figure 6
Figure 6
Distribution of Postoperative Refractive Error in Aphakic Eyes. Postoperative refractive error reported for 416 eyes with a mean of +17.65 D (range = −12.00 D to +35.00 D).
Figure 7
Figure 7
Distribution of Target Refractive Error in Pseudophakic Eyes. The target refractive error varied from −8.50 to +8.00 Diopters for 689 eyes with a reported target.
Figure 8
Figure 8
Distribution of Target Refractive Error Stratified by Age at Surgery. Target refractive error, reported for 689 eyes, appeared to decrease with age; more hyperopia was planned for younger children. The top and bottom of each box represent the 75th and 25th percentiles of the data, respectively. Group medians are represented by the horizontal line in each box and group means by filled circles. The bars extending above and below each box represent 1.5 times the interquartile range (difference between the 75th and 25th percentiles), or the maximum (or minimum) observed value within the range if not as extreme as the calculated value. The open circles represent statistical outliers.
Figure 9
Figure 9
Distribution of Prediction Error in Pseudophakic Eyes. Prediction error (Diopters) was calculated for 599 eyes for which there were both a target refractive error and a postoperative refractive error.
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