Better Cataract Surgery Outcomes Noted in Older Children

Girl Eye Test
Performing lensectomy with in-the-bag primary intraocular lens implantation combined with posterior capsulectomy and anterior vitrectomy is preferable to aphakia for children aged between 2-7 years, according to the investigators.

Performing bilateral cataract surgery in children aged between 2 and 7 years results in fewer adverse events and better visual acuity outcomes compared with infants and toddlers, according to a study published in the Journal of American Association for Pediatric Ophthalmology and Strabismus.

Researchers mined the records of children who received bilateral cataract surgery (114 eyes of 57 patients, age range 2-7 years, 35 boys) with a postoperative follow-up of 2 years or more. They noted best-corrected visual acuity (BCVA), strabismus requiring surgery instances, adverse events and reoperations, and compared their findings with data from a registry containing study data evaluating similar outcome measures in infants and toddlers (Toddler Aphakia Pseudophakia Study [TAPS] registry). Participants in the TAPS registry were stratified into 2 cohorts consisting of patients aged 1-7 months (TAPS 1) and 7 months to 2 years (TAPS 2). 

Investigators measured BCVA of the best-seeing eye at 0.05 logMAR and 0.18 logMAR in the worst-seeing eye during visits conducted closest to participants turning 10 years of age. They found that poor visual outcome risks were higher in TAPS 1 and TAPS 2 participants compared with the study sample (OR=6.7; P =.015 and OR=7.97; P =.007, respectively).

Only 1 patient received surgery for strabismus, and no cases of glaucoma or suspected glaucoma were noted. Adverse events occurred in 7% of eyes, which was significantly lower than adverse events occurring in the TAPS 1 and TAPS 2 groups (46%; OR=11.8; P <.0001 and 20%; OR=3.3; P =.01, respectively). In total, 4 eyes required unanticipated intraocular reoperations (3 membranectomy/vitrectomy and 1 lysis of vitreous wick).

The team noted visual acuity of 20/200 or worse in 2% of eyes and attributed this to deprivation amblyopia secondary to increased eye lengths. 

Researchers highlight the finding of fewer adverse events in children aged between 2-7 years and state that “lensectomy with in-the-bag primary intraocular lens (IOL) implantation combined with posterior capsulectomy and anterior vitrectomy should continue to be the preferred alternative to aphakia from 2 to 7 years of age at surgery.”

Study limitations include its retrospective nature and lack of a standardized approach or randomization.


Adams C, Alex A, Trivedi R, Wilson ME. Outcomes of bilateral cataract surgery in children 2-7 years of age: a comparison to surgery in toddlers and infants. J AAPOS. Published online May 13, 2022. doi:10.1016/j.jaapos.2022.02.011.