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Outcomes and Complications 5 Years After Surgery for Pediatric Cataract Associated With Persistent Fetal Vasculature
Kathryn M Haider1, Michael X Repka2, Desirae R Sutherland3
1Riley Hospital for Children (K.M.H.), Indianapolis, Indiana, USA.
Insights
Children with persistent fetal vasculature (PFV) cataract have varied visual outcomes, with only 10% achieving age-normal vision after surgery. Glaucoma-related adverse events remain a significant risk following PFV cataract treatment.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Genetics
Background:
- Persistent fetal vasculature (PFV) is a congenital condition that can lead to unilateral, non-traumatic cataracts in children.
- Early diagnosis and surgical intervention are crucial for managing PFV-associated cataracts to optimize visual outcomes.
- Understanding the long-term results of cataract surgery in PFV patients is essential for guiding clinical practice.
Purpose of the Study:
- To evaluate the 5-year postoperative outcomes for children undergoing cataract surgery for persistent fetal vasculature (PFV).
- To compare visual acuity and complication rates in PFV cataract eyes versus non-PFV cataract eyes.
Main Methods:
- A clinical cohort study utilizing pediatric cataract registry data from annual medical records.
- Included 64 children under 13 years with unilateral, non-traumatic PFV cataract.
- Assessed age-normal visual acuity (VA), VA better than 20/200, complications, and additional surgeries at 5 years.
Main Results:
- Overall, 10% of eyes achieved age-normal VA at 5 years.
- 59% of aphakic PFV eyes achieved VA better than 20/200, compared to 43% of non-PFV aphakic eyes.
- Glaucoma-related adverse events were the most common complication in aphakic PFV eyes (24%), with no significant difference compared to non-PFV eyes in infants.
Conclusions:
- Cataract surgery in children with PFV yields a wide range of visual results, with a low probability of achieving age-normal vision.
- Persistent fetal vasculature is associated with a continued risk of developing glaucoma-related complications post-surgery.
- Further research is needed to improve long-term visual outcomes and manage complications in PFV cataract patients.
Purpose:
To report 5-year outcomes after surgery for cataract associated with persistent fetal vasculature (PFV).
Design:
Clinical cohort study using pediatric cataract registry data collected annually from medical records.
Methods:
This study included 64 children <13 years of age who were undergoing surgery for unilateral, nontraumatic cataract associated with PFV. Proportions with age-normal visual acuity (VA) and VA better than 20/200 at 5 years' follow-up were estimated. Cumulative incidences of complications and additional surgeries by 5 years were calculated. Outcomes were compared between eyes with unilateral PFV and eyes with unilateral non-PFV cataract from our registry.
Results:
Forty-eight of 64 eyes were aphakic postoperatively (median age at surgery 2 months [range 1-13 months]) and 16 were pseudophakic (29 months [range 2-92 months]). Overall, 4 of 42 eyes (10% [95% confidence interval {CI} 3%-23%]) achieved age-normal VA. VA better than 20/200 was achieved in 17 (59% [95% CI 39%-76%]) unilateral aphakic PFV eyes and 44 (43% [95% CI 32%-54%]) unilateral non-PFV aphakic eyes (age-adjusted odds ratio = 1.90 [95% CI 0.81-4.50]; P = .14). The most common complication in aphakic PFV eyes was glaucoma-related adverse events (cumulative incidence 24% [95% CI 9%-37%]). There was no significant difference in glaucoma-related adverse events between PFV and non-PFV eyes in aphakic participants ≤1 year of age at lensectomy (age-adjusted hazard ratio = 1.20 [95% CI 0.54-2.64], P = .66).
Conclusions:
A wide range of visual outcomes for PFV cataract were observed with a 10% probability of achieving age-normal VA. There was an ongoing risk for the development of glaucoma-related adverse events in PFV eyes.
