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Factors Associated with Retinal Detachment after Pediatric Cataract Surgery in the IRIS® Registry
Francisco Altamirano1, Ju Hyun Jeon1, Ju-Yeun Lee1
1Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Pediatric cataract surgery patients with ocular trauma, aphakia, or specific conditions face higher retinal detachment risks. Early identification of these factors is crucial for preventing vision loss.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Public Health
Background:
- Pediatric cataract surgery is a critical procedure for vision restoration in children.
- Retinal detachment (RD) is a potential sight-threatening complication following pediatric cataract surgery.
- Understanding risk factors is essential for improving patient outcomes.
Purpose of the Study:
- To identify factors associated with retinal detachment (RD) after pediatric cataract surgery.
- To leverage the American Academy of Ophthalmology's Intelligent Research in Sight (IRIS) Registry for this analysis.
- To inform preoperative decision-making and long-term monitoring strategies.
Main Methods:
- Retrospective cohort study utilizing the IRIS Registry (2013-2020).
- Included children (<18 years) who underwent cataract surgery.
- Kaplan-Meier estimator and multivariable Cox regression models were used to analyze cumulative incidence and hazard ratios for RD.
Main Results:
- The cumulative incidence of RD diagnosis and repair within 5 years was 3.8% and 1.6%, respectively.
- Increased RD risk was associated with ocular trauma, aphakia, premature retina, persistent fetal vasculature, and Hispanic ethnicity.
- Similar risk factors were observed for RD requiring surgical repair.
Conclusions:
- Ocular trauma, aphakia, premature retina, persistent fetal vasculature, and Hispanic ethnicity are significant risk factors for RD post-pediatric cataract surgery.
- Identifying these risk factors is vital for guiding surgical decisions and patient monitoring.
- Proactive management can help mitigate the risk of RD in vulnerable pediatric populations.
Purpose:
This study leverages the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight) to identify factors associated with retinal detachment (RD) after pediatric cataract surgery.
Design:
Retrospective cohort study.
Participants:
All children (age < 18 years) who underwent cataract surgery between January 2013 and December 2020 at practices that participate in the IRIS Registry.
Methods:
Data collected included patient demographics and medical history. Current Procedural Terminology codes were used to identify procedures for cataract surgery and RD repair. International Classification of Disease codes were used to classify diagnoses such as degenerative high myopia, persistent fetal vasculature, retinopathy of prematurity, ocular trauma, and retinal detachment. The Kaplan-Meier estimator was used to determine the cumulative incidence of retinal detachment diagnosis and repair after cataract surgery. Hazard ratios with 95% confidence intervals were calculated using multivariable Cox regression models.
Main Outcome Measures:
Cumulative incidence of RD diagnosis and repair within 5 years of cataract surgery.
Results:
Seven thousand four hundred seven children (53% male, 49% White non-Hispanic) were identified and included. The cumulative incidence of retinal detachment diagnosis and repair after cataract surgery was 3.8% (95% CI, 3.1%-4.5%) and 1.6% (95% CI, 1.2%-2.0%), respectively. Children with a history of ocular trauma (hazard ratio [HR], 2.22; 95% CI 1.39-3.57; P < 0.001), aphakia (HR, 2.10; 95% CI, 1.43-3.10; P < 0.001), premature retina (HR 2.73; 95% CI, 1.36-5.48; P = 0.005), persistent fetal vasculature (HR, 3.26; 95% CI, 1.58-6.71; P = 0.001), and Hispanic ethnicity (HR, 1.71; 95% CI, 1.15-2.54; P = 0.008) were at increased risk of RD diagnosis within 5 years of cataract surgery. Similar risk factors were identified for RD requiring surgical repair.
Conclusions:
Among children undergoing cataract surgery in the IRIS Registry, RD was associated with a history of ocular trauma, aphakia, premature retina, persistent fetal vasculature, and Hispanic ethnicity. Identifying risk factors for complications after cataract surgery is essential to guide preoperative decision-making and long-term monitoring to mitigate RD risk in vulnerable patients.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
