Anterior vitrectomy reduces complications in pediatric cataract surgery, age and IOL location play minor roles

Performing anterior vitrectomy during pediatric lensectomy with primary intraocular lens (IOL) implantation significantly reduces the incidence of complications, particularly the need for surgery due to visual axis opacification (VAO), according to a study. Age at surgery and IOL location were found to have no significant impact on the occurrence of VAO, highlighting the importance of long-term monitoring for potential glaucoma development across all age groups.

The study included 609 eyes from 491 children with a mean age of 5.6 years.

Following cataract extraction with primary IOL implantation, the most frequent complication observed was surgery for visual axis opacification (VAO), which had a cumulative incidence of 32% within the study population.

The study found that the cumulative incidence of VAO was significantly lower in cases where anterior vitrectomy was performed at the time of IOL placement (12%) compared to those without anterior vitrectomy (58%). Not performing anterior vitrectomy was associated with a higher risk of requiring surgery for VAO.

These findings emphasize the importance of incorporating anterior vitrectomy into the surgical procedure to reduce the occurrence of complications.

The study did not find any significant differences in the incidence of surgery for VAO based on the age of the child at the time of surgery or the location of IOL fixation (capsular bag vs sulcus). Adjusting for anterior vitrectomy at lens surgery, there were no statistically significant associations between age at surgery or IOL location and the incidence of surgery for VAO.

The cumulative incidence of glaucoma plus glaucoma suspect by the 5-year mark was 7%. The development of glaucoma did not differ significantly based on the age of the child after controlling for IOL location and laterality.

Reference
Yen KG, Repka MX, Sutherland DR, et al. Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract. JAMA Ophthalmol. Published online June 22, 2023. doi:10.1001/jamaophthalmol.2023.2335