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Observational Study
. 2021 Jun 1;139(6):647-653.
doi: 10.1001/jamaophthalmol.2021.0980.

Visual Outcomes and Complications After Lensectomy for Traumatic Cataract in Children

Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG); Erick D Bothun  1 , Michael X Repka  2 , Trevano W Dean  3 , Michael E Gray  4 , Phoebe D Lenhart  5 , Zhuokai Li  3 , David G Morrison  6 , David K Wallace  7 , Raymond T Kraker  3 , Susan A Cotter  8 , Jonathan M Holmes  9
Collaborators, Affiliations
Observational Study

Visual Outcomes and Complications After Lensectomy for Traumatic Cataract in Children

Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG) et al. JAMA Ophthalmol. .

Abstract

Importance: The Pediatric Eye Disease Investigator Group Cataract Registry provides a multicenter assessment of visual outcomes and complications after lensectomy for traumatic pediatric cataract.

Objective: To report visual acuity (VA) and the cumulative proportion with strabismus, glaucoma, and other ocular complications by 15 months after lensectomy for traumatic cataract among children younger than 13 years at the time of surgery.

Design, setting, and participants: From June 18, 2012, to July 8, 2015, 1266 eyes of 994 children from 33 pediatric eye care practices seen within 45 days after lensectomy were enrolled in a multicenter, prospective observational registry. Of these, 74 eyes of 72 participants undergoing lensectomy for traumatic cataract were included in a cohort study. Follow-up was completed by November 2, 2015, and data were analyzed from March 20, 2018, to July 7, 2020.

Exposures: Lensectomy after ocular trauma.

Main outcomes and measures: Best-corrected VA from 9 to 15 months after lensectomy for traumatic cataract (for those 3 years or older) and the cumulative proportion with strabismus, glaucoma, and other ocular complications by 15 months.

Results: Of 994 participants in the registry, 84 (8%) had traumatic cataract. The median age at lensectomy for 72 participants examined within 15 months after surgery was 7.3 (range, 0.1-12.6) years; 46 (64%) were boys. An intraocular lens was placed in 57 of 74 eyes (77%). In children 3 years or older at outcome, the median best-corrected VA was 20/250 (range, 20/20 to worse than 20/800) in 6 eyes with aphakia and 20/63 (range, 20/20 to 20/200) in 26 eyes with pseudophakia. Postoperative visual axis opacification was reported in 18 of 27 eyes with pseudophakia without primary posterior capsulotomy (15-month cumulative proportion, 77%; 95% CI, 58%-92%). The cumulative proportion with strabismus was 43% (95% CI, 31%-58%) in 64 participants with ocular alignment data; exotropia was present in 14 of 23 participants (61%). The cumulative proportion with glaucoma was 6% (95% CI, 2%-16%).

Conclusions and relevance: Trauma was not a common cause of pediatric cataract requiring surgery. For children with traumatic cataract, substantial ocular morbidity including permanent vision loss was found, and long-term eye and vision monitoring are needed for glaucoma, strabismus, and capsular opacification.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Repka reported consulting for Alcon since August 2020 for purposes of explaining the Pediatric Eye Disease Investigator Group (PEDIG) Cataract Registry data to the company for their possible use in a US Food and Drug Administration labeling application. Mr Dean reported receiving grants from the National Eye Institute of the National Institutes of Health (NEI/NIH) during the conduct of the study. Dr Wallace reported receiving grants from the NEI/NIH during the conduct of the study. Mr Kraker reported receiving grants from the NEI/NIH for the Jaeb Center for Health Research as a coordinating center for PEDIG research during the conduct of the study. Dr Cotter reported receiving grants from the NEI/NIH during the conduct of the study. Dr Holmes reported receiving grants from the NIH during the conduct of the study and outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Distribution of Best-Corrected Visual Acuity Measured From 9 to 15 Months After Lensectomy According to Procedures Performed at Lensectomy
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; group means are represented 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. Visual acuity was reported for 32 eyes (21 with and 11 without anterior vitrectomy and 26 with and 6 without intraocular lens [IOL] implantation). An intraocular lens was placed in the capsular bag in 19 eyes, in the sulcus in 6 eyes, and placement was unknown in 1 eye. Statistical comparisons were not performed due to the small sample sizes.
See this image and copyright information in PMC

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