Glaucoma risk increases in young children post-cataract surgery: JAMA

USA: A new study shows that glaucoma or glaucoma-like symptoms were prevalent in children 5 years following lensectomy. During the first five years after an intraocular lens (IOL) was implanted, myopia shifted only slightly, which should be considered when choosing an implant power. The findings of this study were published in the journal JAMA Ophthalmology.

A cataract is a common cause of vision loss in youngsters. Real-world estimates of visual outcomes and the 5-year cumulative incidence of adverse events can be derived from data from a large pediatric cataract surgery registry. As a result, Michael X. Repka and colleagues conducted this study to examine visual acuity (VA), the incidence of complications and further eye procedures, and refractive error outcomes in children younger than 13 years after pediatric lensectomy.

The Pediatric Eye Disease Investigator Group clinical research registry was used in this prospective cohort study. Between June 2012 and July 2015, 61 eye care practices in the United States, Canada, and the United Kingdom enrolled children aged birth to less than 13 who had undergone lensectomy for any reason within the previous 45 days. After that, data were collected from medical record reviews on an annual basis for the next 5 years, until September 28, 2020. Lensectomy with or without intraocular lens implantation was performed on the participants. From 4 to 6 years following the first lensectomy, best-corrected VA and refractive error were measured. The 5-year incidence of glaucoma or glaucoma suspect, as well as further eye procedures, was assessed using Cox proportional hazards regression.

The key findings were as follow:

1. In total 994 children (1268 eyes) had their lenses removed bilaterally or unilaterally.

2. The median VA among 701 eyes with available VA data (55%) was 20/63 (range, 20/40 to 20/100) in 182 of 316 bilateral aphakic eyes (58%) and 20/32 (range, 20/25 to 20/50) in 209 of 386 bilateral pseudophakic eyes (54%) and 20/200 (range, 20/50 to 20/618) in 124 of 202 unilateral aphakic eyes (61%) and 20/65 (range (51% ).

3. Participants with bilateral aphakia had a 46% 5-year cumulative incidence of glaucoma or glaucoma suspicion, compared to 7% in those with bilateral pseudophakia, 25% in those with unilateral aphakia, and 17% in those with unilateral pseudophakia.

4. Clearing the visual axis was the most common subsequent eye surgery, with a 5-year cumulative incidence of 13% in those with bilateral aphakia, 33% in those with bilateral pseudophakia, 11% in those with unilateral aphakia, and 34% in those with unilateral pseudophakia.

5. Among 89 bilateral aphakic eyes, the median 5-year change in spherical equivalent refractive error was 8.38 D (IQR, 11.38 D to 2.75 D), 1.63 D (IQR, 3.13 D to 0.25 D) among 130 bilateral pseudophakic eyes, 10.75 D (IQR, 20.50 D to 4.50 D) among 43 unilateral aphakic eyes, and 1.94 D (IQR, 3.25 D to 0.69 D) among 112.

In conclusion, during the first five years after cataract surgery, amblyopia was common, and the chance of developing glaucoma increased. After primary IOL implantation, refractive error was firmly grouped around emmetropia.

Reference:

Repka MX, Dean TW, Kraker RT, et al. Visual Acuity and Ophthalmic Outcomes 5 Years After Cataract Surgery Among Children Younger Than 13 Years. JAMA Ophthalmol. Published online February 10, 2022. doi:10.1001/jamaophthalmol.2021.6176