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Comment
. 2023 Aug 1;141(8):705-714.
doi: 10.1001/jamaophthalmol.2023.2335.

Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract

Kimberly G Yen  1 , Michael X Repka  2 , Desirae R Sutherland  3 , Kathryn M Haider  4 , Sarah R Hatt  5 , Raymond T Kraker  3 , Jennifer A Galvin  6   7 , Zhuokai Li  3 , Susan A Cotter  8 , Jonathan M Holmes  9 ; Pediatric Eye Disease Investigator Group
Collaborators, Affiliations
Comment

Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract

Kimberly G Yen et al. JAMA Ophthalmol. .

Abstract

Importance: Lensectomy with primary intraocular lens (IOL) implantation is often used in the management of nontraumatic pediatric cataract, but long-term data evaluating the association of age and IOL location with the incidence of complications are limited.

Objective: To describe the incidence of complications and additional eye surgeries through 5 years following pediatric lensectomy with primary IOL implantation and association with age at surgery and IOL location.

Design, setting, and participants: This prospective cohort study used Pediatric Eye Disease Investigator Group cataract registry data from 61 institution- and community-based practices over 3 years (June 2012 to July 2015). Participants were children younger than 13 years without baseline glaucoma who had primary IOL implantation (345 bilateral and 264 unilateral) for nontraumatic cataract. Data analysis was performed between September 2021 and January 2023.

Exposures: Lensectomy with primary IOL implantation.

Main outcome and measures: Five-year cumulative incidence of complications by age at surgery (<2 years, 2 to <4 years, 4 to <7 years, and 7 to <13 years) and by IOL location (sulcus vs capsular bag) were estimated using Cox proportional hazards models.

Results: The cohort included 609 eyes from 491 children (mean [SD] age, 5.6 [3.3] years; 261 [53%] male and 230 [47%] female). Following cataract extraction with primary IOL implantation, a frequent complication was surgery for visual axis opacification (VAO) (cumulative incidence, 32%; 95% CI, 27%-36%). Cumulative incidence was lower with anterior vitrectomy at the time of IOL placement (12%; 95% CI, 8%-16%) vs without (58%; 95% CI, 50%-65%), and the risk of undergoing surgery for VAO was associated with not performing anterior vitrectomy (hazard ratio [HR], 6.19; 95% CI, 3.70-10.34; P < .001). After adjusting for anterior vitrectomy at lens surgery, there were no differences in incidence of surgery for VAO by age at surgery (<2 years, HR, 1.35 [95% CI, 0.63-2.87], 2 to <4 years, HR, 0.86 [95% CI, 0.44-1.68], 4 to <7 years, HR, 1.06 [95% CI, 0.72-1.56]; P = .74) or by capsular bag vs sulcus IOL fixation (HR, 1.22; 95% CI, 0.36-4.17; P = .75). Cumulative incidence of glaucoma plus glaucoma suspect by 5 years was 7% (95% CI, 4%-9%), which did not differ by age after controlling for IOL location and laterality.

Conclusions and relevance: In this cohort study, a frequent complication following pediatric lensectomy with primary IOL was surgery for VAO, which was associated with primary anterior vitrectomy not being performed but was not associated with age at surgery or IOL location. The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Repka reported receiving personal fees from Alcon Research as consultant on Pediatric Eye Disease Investigator Group data set following the conduct of the study, a grant from AbbVie as a 1-time consultant on a study idea in uveitis, and medical monitor fees from Luminopia on an amblyopia treatment device prior to US Food and Drug Administration approval outside the submitted work. No other disclosures were reported.

Comment on

References

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