Frequent Monitoring After Pediatric Cataract Surgery Recommended For Glaucoma Detection

Michael X. Repka, MD, MBA

A new study observed the development of glaucoma was common in children 5 years following lensectomy with modest myopic shift after placement of an intraocular lens (IOL), suggesting the need for frequent monitoring after pediatric cataract surgery.

Study author Michael X. Repka, MD, MBA, Wilmer Eye Institute and a team of investigators assessed visual outcomes, complications, and additional eye operations within 5 years following cataract surgery in children.

“This cohort study found that although good VA was possible after cataract surgery in children from birth to less than 13 years of age, age-normal vision was uncommon,” Repka wrote.

In order to characterize management and outcomes of pediatric cataract surgery, a data registry was developed by the Pediatric Eye Disease Investigator Group for children from birth to ≤13 years old who underwent lensectomy.

A total of 61 eye care practices enrolled patients between June 2012 - July 2015, with annual data collection until September 2020. Patients were thus classified under unilateral or bilateral lensectomy, defined as surgery in both eyes by last annual data collection or lensectomy in the fellow eye before study enrollment.

The main study outcomes were considered best-corrected visual acuity and refractive error measured 4 - 6 years after initial lensectomy. Cox proportional hazards regression were used to assess the 5-year incidence of glaucoma or glaucoma suspect and additional eye operations.

Analyses were stratified by whether an IOL was implanted at the initial lensectomy and the eye belonged to a patient who underwent bilateral or unilateral lensectomy.

The registry enrolled 994 children (n = 1268 eyes) undergoing bilateral or unilateral lensectomy, made up of 501 males (51%) with a median age of 3.6 years and a range of 2 weeks to 12.9 years. Data show bilateral surgery was performed in 428 participants (43%) and an IOL was implanted in 750 eyes (59%).

At 5 years, the best-corrected letter optotype visual acuity was reported in 701 of 1182 eyes (59%).

• 20/63 in 182 of 316 (58%) bilateral aphakic eyes
• 20/32 in 209 of 386 (54%) bilateral pseudophakic eyes
• 20/200 in 124 of 202 (61%) unilateral aphakic eyes
• 20/65 in 186 of 364 (51%) unilateral pseudophakic eyes

Repka and colleagues found glaucoma-related adverse events reported in 148 of 1055 eyes (14%) in children who did not have preoperative diagnosis of glaucoma or ocular trauma

The 5-year cumulative incidence of glaucoma or glaucoma suspect was 46% (95% CI, 28% - 59%) in patients with bilateral aphakia, 7% (95% CI, 1% - 12%) in bilateral pseudophakia, 25% (95% CI, 15% - 34%) in unilateral aphakia, and 17% (95% CI, 5% - 28%) in unilateral pseudophakia.

Investigators observed the 5-year cumulative incidence of surgery to clear the visual axis was 13% (95% CI, 8% - 17%) in bilateral aphakic eyes, 33% (95% CI, 26% - 39%) in bilateral pseudophakia, 11% (95% CI, 6% - 15%) in unilateral aphakia, and 34% (95% CI, 28% - 39%) in unilateral pseudophakia.

Additionally, the median 5-year changes in spherical equivalent refractive error were reported:

• -8.38 D in 89 bilateral aphakic eyes
• -1.63 D in 130 bilateral pseudophakic eyes
• -10.75 D in 43 unilateral aphakic eyes
• -1.94 D in 112 unilateral pseudophakic eyes

The study, “Visual Acuity and Ophthalmic Outcomes 5 Years After Cataract Surgery Among Children Younger Than 13 Years,” was published in JAMA Ophthalmology.