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. 2025 Nov 6:e254121.
doi: 10.1001/jamaophthalmol.2025.4121. Online ahead of print.

Visual Outcomes and Complications Over 5 Years Following Lensectomy for Childhood Traumatic Cataract

Erin D Stahl  1 , Desirae R Sutherland  2 , Michael X Repka  3 , Sarah R Hatt  4 , Laura B Enyedi  5 , Jeffrey D Colburn  6 , Hawke H Yoon  7 , David A Leske  4 , Raymond T Kraker  2 , Wesley T Beaulieu  2 , Susan A Cotter  8 , Jonathan M Holmes  9 , Stacy L Pineles  10 , Katherine K Weise  11 ; Pediatric Eye Disease Investigator Group (PEDIG)
Affiliations

Visual Outcomes and Complications Over 5 Years Following Lensectomy for Childhood Traumatic Cataract

Erin D Stahl et al. JAMA Ophthalmol. .

Abstract

Importance: The long-term outcomes of surgery for pediatric traumatic cataract are not well described; understanding these outcomes would inform parental expectations.

Objective: To report visual acuity (VA) outcomes and cumulative incidence of ocular complications by 5 years following lensectomy for pediatric traumatic cataract.

Design, setting, and participants: This prospective cohort study was conducted across 32 sites in the US and Canada among 75 children undergoing lensectomy from birth to less than 13 years of age for unilateral traumatic cataract. Of 75 children, 60 had primary intraocular lens (IOL) placement; 15 were left aphakic. Data were collected from August 2012 to February 2020. Data analysis was performed from October 2022 to May 2025.

Exposure: Lensectomy.

Main outcomes and measures: The primary outcomes were best-corrected VA 5 years after lensectomy; period prevalence of strabismus and glaucoma (including cases diagnosed before lensectomy); surgery for visual axis opacification (VAO); and cumulative incidence of ocular complications by 5 years. Annual data collection was from medical record reviews through 5 years following lensectomy.

Results: Among 75 participants, 28 (37%) were female, and median (range) age at lensectomy was 7.4 years (0.1-13 years). Median (IQR) best-corrected VA at 5 years (available for 37 participants [49%]) was 20/63 (20/35-20/159) in pseudophakic eyes (n = 29; mean [SD] age at surgery, 7.2 [3.0] years) and 20/258 (20/56-<20/800) in aphakic eyes (n = 8; mean [SD] age at surgery, 5.5 [4.3] years). Age-normal VA was achieved by 6 pseudophakic eyes (21%; 95% CI, 10%-38%) and 1 aphakic eye (13%; 95% CI, 2%-47%). The 5-year period prevalence of glaucoma was 9% in pseudophakic eyes (95% CI, 1%-16%) and 9% in aphakic eyes (95% CI, 0%-24%). The 5-year cumulative incidence of surgery for VAO was 47% in pseudophakic eyes (95% CI, 31%-60%) and 13% in aphakic eyes (95% CI, 0%-28%). The risk was greater in eyes that did not undergo an anterior vitrectomy (84%; 95% CI, 55%-94%) vs eyes that did (15%; 95% CI, 2%-26%) (age-adjusted hazard ratio, 11.4; 95% CI, 4.6-33.1; P < .001).

Conclusions and relevance: In this cohort study, while only half of the study participants had a 5-year follow-up visit, achieving age-normal VA was uncommon among the cohort in whom a best-corrected VA was determined. The prevalence of glaucoma at 5 years was low among those with 5-year follow-up, while nearly half of the pseudophakic eyes needed surgery for VAO supporting the need to monitor these children.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Stahl reported personal fees from Epion Therapeutics, Santen Pharmaceutical Co, and Sydnexis and equity ownership in Treehouse Health outside the submitted work. Dr Repka reported grants from the National Eye Institute (NEI) during the conduct of the study. Dr Enyedi reported grants from Ocular Therapeutix outside the submitted work. Dr Colburn reported personal fees from PEDIG during the conduct of the study. Ms Sutherland, Mr Kraker, and Dr Beaulieu reported grants from the NEI of the US National Institutes of Health (NIH) as a coordinating center for PEDIG during the conduct of the study. Dr Cotter reported grants from NIH/NEI during the conduct of the study. Dr Holmes reported grants from the NIH during the conduct of the study and outside the submitted work. Dr Weise reported grants from the NIH/NEI Jaeb Center for Health Research PEDIG during the conduct of the study. No other disclosures were reported.

References

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