Glaucoma Development, Myopic Shifts Noted Following Pediatric Cataract Surgery

The development of glaucoma, or glaucoma suspect, is common in children 5 years after cataract surgery, according to research published in JAMA Ophthalmology. Secondary findings also revealed a modest myopic shift for pseudophakic children during the same time period.

Researchers enrolled 994 children (median age 3.6 years, 51% boys, 1268 eyes) who underwent cataract surgery between 2012 and 2015 in a multi-center, prospective cohort study. They reviewed patient records yearly for five years to assess surgical and visual outcomes. Among participants, 43% underwent bilateral surgery and 59% of eyes received an intraocular lens.

Researchers included 701 eyes at 5 year follow-up after considering eyes with available visual acuity (VA) data. Median VA was 20/63 for bilateral aphakic eyes (58%), 20/32 for bilateral pseudophakic eyes (54%), 20/200 for unilateral aphakic eyes (61%), and 20/65 for unilateral pseudophakic eyes (51%). Participants achieved age-normal VA in 20% (n=37, 95% CI, 13-27%), 42% (n=88, 95% CI, 34-50%) 12% (n=15, 95% CI, 7-19%), and 18% (n=34, 95% CI, 13-25%) of eyes, respectively.

The median change in spherical equivalent (SE) refractive error was −8.38 D for bilateral aphakic eyes, −1.63 D for bilateral pseudophakic eyes, −10.75 D for unilateral aphakic eyes, and −1.94 D for unilateral pseudophakic eyes at 5 year follow-up. Researchers noted a general myopic shift within 45 days of surgery among all subgroups.

A total of 14% of children with no preoperative trauma or diagnosis experienced glaucoma-related adverse events. The 5 year cumulative occurrence of glaucoma was 46% (95% CI, 28-59%) among bilateral aphakic eyes, 7% (95% CI, 1-12%) among bilateral pseudophakic eyes, 25% (95% CI, 15-34%) among unilateral aphakic eyes, and 17% (95% CI, 5-28%) among unilateral pseudophakic eyes.

“Although good VA was possible after cataract surgery in children from birth to less than 13 years of age, age-normal vision was uncommon,” according to the investigators. “Amblyopia was frequent, and the risk for development of glaucoma increased during the first 5 years after cataract surgery.”

This study was limited by a high dropout rate and the exclusion of children who were unable to perform letter optotypes from VA analysis.

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. 2022;140(3):269-276. doi:10.1001/jamaophthalmol.2021.6176