Development of cataract after lens-sparing vitrectomy in pediatric eyes and risk factors

To assess the rate and risk factors for cataract formation following lens-sparing vitrectomy (LSV) in pediatric eyes.

The medical records of patients <18 years of age who underwent LSV for various vitreoretinal conditions were examined retrospectively. The incidence and timing of postoperative cataract formation, lensectomy rates, and risk factors were assessed.

A total of 235 patients (295 eyes) were included. Median age at LSV was 4 months (range, 1-179). Cataract developed in 63 eyes (21.4%), and lensectomy was required in 31 eyes (10.5%) at a median follow-up of 33 months (range, 1-190). The median time to cataract development was 8 months (range, 1-123) after surgery. Cataracts developed in 60% of eyes within the first year, 10% in the second year, and 30% thereafter. Kaplan-Meier analysis showed estimated rates of clear lens and phakia were 87% and 94% at 1 year, and 74% and 77% at 5 years, respectively. Significant predictors of cataract development included lens-fibrovascular membrane-retina apposition (P = 0.001; OR = 3.663), repeat surgeries (P = 0.01; OR = 2.120), and silicone oil tamponade (P = 0.04; OR = 3.154).

Most eyes in our cohort retained lens clarity after LSV. However, cataract formation is a risk in cases with significant lens-fibrovascular membrane-retina apposition, repeat vitreoretinal surgeries, lens trauma, and silicone oil tamponade, necessitating closer follow-up, particularly during the first postoperative year.