1. Jun 04, 2019

Are Ophthalmic Outcomes Worse for Children Younger Than 13 Years After Cataract Surgery?

Real-world estimates of visual outcomes and rates of adverse events in clinical practice are detailed in a new study in JAMA Ophthalmology. The study examined visual acuity and refractive error outcomes, and rates of amblyopia, glaucoma, and additional eye surgery during the first year after lensectomy in children younger than 13 years.

The study was conducted from June 2012 to July 2015 at 61 pediatric eye care practices and included 880 children younger than 13 years at the time of lensectomy with follow-up within 15 months.

Among the 880 children (432 girls and 448 boys; mean [SD] age at annual follow-up, 4.9 [3.8] years), lens surgery was bilateral in 362 (41.1%; 95% CI, 37.9%-44.4%) and unilateral in 518 (58.9%; 95% CI, 55.6%-62.1%). An intraocular lens was implanted in 654 of 1132 eyes and amblyopia was identified in 449 children.

The researchers found the following:

  • Mean visual acuity improved with older age at surgery in eyes with bilateral pseudophakia by 0.2 logMAR line and by 0.3 logMAR line in eyes with unilateral pseudophakia.
  • New diagnoses of glaucoma or suspected glaucoma were made in 67 of 1064 eyes that did not have glaucoma prior to lensectomy, 36 of 273 eyes with bilateral aphakia, 5 of 308 eyes with bilateral pseudophakia, 14 of 178 eyes with unilateral aphakia, and 12 of 305 eyes with unilateral pseudophakia.
  • Mean visual acuity improved in older patients at surgery in eyes with bilateral pseudophakia by 0.2 logMAR line and by 0.3 logMAR line in eyes with unilateral pseudophakia.

Amblyopia was frequently observed during the first year after lensectomy. Children age 2 years or older at surgery had visual acuity that was typically less than normal for age and was worse with unilateral cataract.

Reference:

Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG). Visual acuity and ophthalmic outcomes in the year after cataract surgery among children younger than 13 years [published online ahead of print May 17, 2019]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2019.1220.