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Published on: December 1, 2023
Prognostic factors and postoperative outcomes in pediatric cataract patients: A systematic review and meta-analysis
Irene Schiavetti1, Andrea Lembo2, Emma Bersani2
1Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy; IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy.
Insights
Shorter preoperative axial length and primary intraocular lens implantation increase risks for visual axis opacification and secondary glaucoma after pediatric cataract surgery. Careful planning and long-term follow-up are crucial.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Clinical Research
Background:
- Pediatric cataract surgery carries risks of postoperative complications.
- Understanding prognostic factors is vital for managing these risks.
- Previous estimates of complication incidence require updating.
Purpose of the Study:
- To provide updated pooled estimates for major postoperative complications after pediatric cataract surgery.
- To identify clinical and surgical prognostic factors associated with these complications.
- To inform surgical planning and follow-up strategies.
Main Methods:
- Systematic literature search of PubMed, Scopus, and Web of Science.
- Inclusion of 87 studies reporting postoperative outcomes in pediatric cataract surgery.
- Meta-regression analyses to identify prognostic factors for visual axis opacification, reintervention, and secondary glaucoma.
Main Results:
- Pooled incidences: 12% for visual axis opacification, 9.2% for reintervention, and 2.3% for secondary glaucoma.
- Shorter preoperative axial length significantly associated with increased risk of all three outcomes.
- Primary intraocular lens implantation independently associated with higher risk of visual axis opacification and reintervention.
Conclusions:
- Shorter axial length and primary intraocular lens implantation are key predictors of complications.
- Findings emphasize the need for meticulous surgical planning in pediatric cataract surgery.
- Highlights the importance of standardized reporting and long-term glaucoma surveillance.
Abstract:
We provide updated pooled estimates of the incidence of major postoperative complications after congenital or pediatric cataract surgery--visual axis opacification (VAO), VAO requiring reintervention, and secondary glaucoma--and identify clinical and surgical prognostic factors associated with these outcomes. We conducted a systematic search of PubMed, Scopus, and Web of Science. Studies reporting postoperative outcomes after pediatric cataract surgery were included. Pooled incidence rates were calculated using fixed- and random-effects models. Univariable and multivariable meta-regression analyses evaluated associations between outcomes and covariates including age at surgery, sex, anterior vitrectomy, primary intraocular lens (IOL) implantation, preoperative axial length (AL), and intraocular pressure. Eighty-seven studies (mean sample: 60.8 patients; 94.9 analysed eyes) met inclusion criteria. Under the random-effects model, pooled incidences (95% CI) were 12% (8%-16%) for VAO, 9.2% (6.0%-13.8%) for VAO requiring surgical reintervention, and 2.3% (1.3%-3.9%) for secondary glaucoma. Shorter preoperative axial length was significantly associated with higher risk of all 3 outcomes. Primary IOL implantation was independently associated with increased risk of VAO and reintervention, while anterior vitrectomy showed a significant association with secondary glaucoma in univariable analysis. Long-term postoperative visual acuity could not be meta-analyzed due to inconsistent reporting. We found that shorter AL and primary IOL implantation are predictors of postoperative complications following pediatric cataract surgery. These findings support careful surgical planning and highlight the need for standardized reporting and long-term follow-up, particularly for glaucoma surveillance.
