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Cataract Surgery in Children from Birth to Less than 13 Years of Age: Baseline Characteristics of the Cohort
Michael X Repka1, Trevano W Dean2, Elizabeth L Lazar2
1Wilmer Institute, Baltimore, Maryland.
Insights
Pediatric lensectomy outcomes show low complication rates and near-universal intraocular lens (IOL) use in older children. Refractive outcomes varied, with about half of eyes achieving target refraction within 1 diopter.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Refractive Surgery
Background:
- Lensectomy in children is performed for various reasons, necessitating an understanding of outcomes.
- Data on baseline characteristics, surgical complications, and refractive results in pediatric lensectomy patients are limited.
Purpose of the Study:
- To characterize baseline features, postoperative refractive errors, operative complications, and intraocular lens (IOL) prediction error in children undergoing lensectomy.
- To evaluate refractive outcomes following pediatric lensectomy in North America.
Main Methods:
- Prospective registry study involving 1266 eyes of 994 children (birth to <13 years).
- Data collected included refractive error, axial length, ophthalmic examinations, associated conditions, IOL type, and complications.
- Analysis focused on refractive outcomes and IOL prediction error.
Main Results:
- Mean age at surgery was 4.2 years; 34% were under 1 year old. IOL implantation rates increased significantly with age (8% <1 year, 78% 1-2 years, 90% 2-13 years).
- Intraoperative complications occurred in 5% of eyes. The prediction error for implanted IOLs was <1.00 diopter in 54% of eyes and >2.00 diopters in 15% of eyes.
- About half of eyes achieved a postoperative refraction within 1 diopter of the target.
Conclusions:
- Lensectomy is performed across childhood, with increasing IOL use in older children.
- The surgery demonstrated a low complication rate.
- Achieving target refraction within 1 diopter occurred in approximately 50% of eyes, indicating room for improvement in refractive outcome prediction.
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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