Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract
Authors: Yen Kimberly G. , Repka Michael X. , Sutherland Desirae R. , Haider Kathryn M. , Hatt Sarah R. , Kraker Raymond T. , Galvin Jennifer A. , Li Zhuokai , Cotter Susan A. , Holmes Jonathan M. ,   Pediatric Eye Disease Investigator Group, Freedman Sharon F. , Wallace David K. , Enyedi Laura B. , Prakalapakorn Sasapin , Jones Sarah K. , Hug Denise , Stahl Erin D. , Dent Rebecca J. , Kong Lingkun , Wang Serena , Gallerson Bryan K. , Hutchinson Amy K. , Lenhart Phoebe , Brower Judy , Morrison David G. , Ruark Scott T. , Mets-Halgrimson Rebecca , Yoon Hawke , Ralay-Ranaivo Hantamalala , Hamidullah Aaliyah , Areaux Raymond , Anderson Jill S. , Holleschau Ann M. , Superstein Rosanne , Belanger Caroline , Fallaha Nicole , Hamel Patrick , Thibeault Maryse , Tamkins Susanna M. , Chang Ta , Park Hee-Jung S. , Trumler Anya A. , Liu Xiaonong , Astle William F. , Sanders Emi N. , Traboulsi Elias , Ghasia Fatema , McOwen Diana C. , Gray Michael E. , Yang Michael B. , Bowman Corey S. , Therriault Margaret , Smith Heather , Whitaker Michele E. , Orge Faruk , Grigorian Adriana P. , Baird Alicia M. , Strominger Mitchell B. , Chen Vicki , Klein Shelley , Kemmer Jacquelyn D. , Neiman Alexandra E. , Mendoza Myra N. , Frohwein Jill J. , Bremer Don , Cassady Cybil , Golden Richard , Jordan Catherine , Rogers David , Oravec Sara A. , Yanovitch Tammy L. , Lunsford Keven , Nye Christina , Shea Caroline , Stillman SueAnn M. , LaRoche G. Robert , Van Iderstine Stephen C. , Robertson Elisa , Cruz Oscar A. , Ghadban Rafif , Govreau Dawn , Larson Scott A. , Longmuir Susannah , Shan Xiaoyan , Clarke Michael P. , Taylor Kate , Powell Christine , Hammond Benjamin P. , Gearinger Matthew D. , Czubinski Andrea , Hendricks Dorothy H. , Jin Jing , Salvin Jonathan H. , Fisher Alicia , Lee Katherine A. , Brooks Daniel , Schweinler Bonita R. , Sala Nicholas A. , Sala Allyson M. , Summers Allison I. , Karr Daniel J. , Wilson Lorri B. , Rauch Paula K. , O'Hara Mary , Gandhi Nandini , Hashmi Tania , Colburn Jeffrey , Dittman Eileen , Whitfill Charles R. , Wheeler Amy M. , McCourt Emily A. , Singh Jasleen , Welnick Nanastasia , Azar Nathalie F. , Baker Joseph , Droste Patrick J. , Peters Robert J. , Hilbrands Jan , Pineles Stacy L. , Bernardo Marianne J. , Peterson Edward , Peterson Charla H. , Kumar Kartik , Melese Ephrem , Lingua Robert , Grijalva Jeff , Crouch Earl R. , Crouch Earl R. , Ventura Gaylord , Anninger William , Benson Shawn L. , Karp Karen A. , Smith Jordana M. , Brickman-Kelleher Jill , Ticho Benjamin H. , Khammar Alexander J. , Clausius Deborah A. , Guo Suquin , Suh Donny , Chamberlain Carolyn , Schloff Susan , Madigan William P. , Burkman Donna , Christiansen Stephen P. , Ramsey Jean E. , McConnell Kate H. , Friedman Ilana , Rosado Jose , Sauberan Donald P. , Hemberger Jody C. , Davis Patricia L. , Rudaitis Indre , Lowery Robert S. , Cupit Shawn , Bothun Erick D. , Mohney Brian G. , Wernimont Suzanne M. , Neilsen Rebecca A. , Herlihy Erin P. , Baran Francine , Gladstone Amy , Smith Justin , Mellott Mei , Kieser Troy , Erzurum S. Ayse , Colon Beth , Shah Birva , Quebbemann Micaela , Beck Roy W. , Austin Darrell S. , Boyle Nicole M. , Conner Courtney L. , Chandler Danielle L. , Donahue Quayleen , Fimbel Brooke P. , Robinson Julianne L. , Hercinovic Amra , Hoepner James E. , Kaplon Joseph D. , Henderson Robert J. , Melia B. Michele , Ortiz Gillaine , Woodard Victoria C. , Stutz Kathleen M. , Wu Rui , Everett Donald F. , Diener-West Marie , Baker John D. , Davis Barry , Phelps Dale L. , Poff Stephen W. , Saunders Richard A. , Tychsen Lawrence , Bradfield Yasmin S. , Foster Nicole C. , Plager David A. , Salchow Daniel J. , Birch Eileen E. , Manny Ruth E. , Silver Jayne L. , Weise Katherine K. , Verderber Lisa C. , Dean Trevano W. , de Alba Campomanes Alejandra G. , Young Marielle P. , Rahmani Bahram , Whitehead George F. , Lambert Scott R. , Kurup Sudhi P. , Kraus Courtney L. 
Published: June 2023

Importance

Lensectomy with primary intraocular lens (IOL) implantation is often used in the management of nontraumatic pediatric cataract, but long-term data evaluating the association of age and IOL location with the incidence of complications are limited.

Objective

To describe the incidence of complications and additional eye surgeries through 5 years following pediatric lensectomy with primary IOL implantation and association with age at surgery and IOL location.

Design, Setting, and Participants

This prospective cohort study used Pediatric Eye Disease Investigator Group cataract registry data from 61 institution- and community-based practices over 3 years (June 2012 to July 2015). Participants were children younger than 13 years without baseline glaucoma who had primary IOL implantation (345 bilateral and 264 unilateral) for nontraumatic cataract. Data analysis was performed between September 2021 and January 2023.

Exposures

Lensectomy with primary IOL implantation.

Main Outcome and Measures

Five-year cumulative incidence of complications by age at surgery (&amp;lt;2 years, 2 to &amp;lt;4 years, 4 to &amp;lt;7 years, and 7 to &amp;lt;13 years) and by IOL location (sulcus vs capsular bag) were estimated using Cox proportional hazards models.

Results

The cohort included 609 eyes from 491 children (mean [SD] age, 5.6 [3.3] years; 261 [53%] male and 230 [47%] female). Following cataract extraction with primary IOL implantation, a frequent complication was surgery for visual axis opacification (VAO) (cumulative incidence, 32%; 95% CI, 27%-36%). Cumulative incidence was lower with anterior vitrectomy at the time of IOL placement (12%; 95% CI, 8%-16%) vs without (58%; 95% CI, 50%-65%), and the risk of undergoing surgery for VAO was associated with not performing anterior vitrectomy (hazard ratio [HR], 6.19; 95% CI, 3.70-10.34; P &amp;lt; .001). After adjusting for anterior vitrectomy at lens surgery, there were no differences in incidence of surgery for VAO by age at surgery (&amp;lt;2 years, HR, 1.35 [95% CI, 0.63-2.87], 2 to &amp;lt;4 years, HR, 0.86 [95% CI, 0.44-1.68], 4 to &amp;lt;7 years, HR, 1.06 [95% CI, 0.72-1.56]; P = .74) or by capsular bag vs sulcus IOL fixation (HR, 1.22; 95% CI, 0.36-4.17; P = .75). Cumulative incidence of glaucoma plus glaucoma suspect by 5 years was 7% (95% CI, 4%-9%), which did not differ by age after controlling for IOL location and laterality.

Conclusions and Relevance

In this cohort study, a frequent complication following pediatric lensectomy with primary IOL was surgery for VAO, which was associated with primary anterior vitrectomy not being performed but was not associated with age at surgery or IOL location. The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring.