Second intraocular surgery after primary pediatric cataract surgery: indications and outcomes during long-term follow-up at a tertiary eye care center

Abstract

Purpose Although pediatric cataract surgery has become standardized and safe, further surgical interventions are not uncommon. The purpose of this study was to analyze the incidence of complications in children who required an intraocular intervention. Methods A retrospective review of medical records of children (o7 years) with cataract who underwent cataract surgery with or without primary posterior chamber intraocular lens (IOL) placement between January 2006 and December 2014 was carried out. Data were collected regarding visual axis opacification (VAO), glaucoma, IOL decentration, intraocular infections, and other indications that required a second intraocular surgery. Results Out of 814 (570 pseudophakic and 244 aphakic) eyes of 620 operated children, 45 eyes of 40 children (5.5%, 45/814) needed a second surgery. The most common indication being VAO (2.9%, 24/814), followed by glaucoma (0.73%, 6/814). Incidence of complications was higher in children o1 year (VAO 6.1%, 19/308 and glaucoma 6%, 6/308). Among all children, repeat interventions and VAO were slightly less frequent in pseudophakics (4.91%, 28/570) vs aphakics (6.91%, 17/244) (P = 0.31). As VAO was more common in pseudophakic eyes in infants, glaucoma was equally common in both groups. Best-corrected visual acuity improved from 1.6 ± 0.56 LogMAR preoperatively to 0.80 ± 0.50 LogMAR postoperatively. Conclusions Our study suggests that overall incidence of second intraocular surgery is low after primary pediatric cataract surgery. VAO remains the most common indication followed by secondary glaucoma. Incidence of complications is higher in children o1 year of age at initial surgery.

Angle Surgery in Pediatric Glaucoma Following Cataract Surgery

“…Time between cataract surgery and glaucoma diagnosis has ranged in the literature from 2.5 months to over 5 years [ 11 , 23 , 24 ]. In addition, associations between risk of GFCS and various factors of the cataract surgery have been investigated, such as aphakia vs. pseudophakia after cataract extraction, and use of intra-operative anti-inflammatory agent [ 25 , 26 , 27 , 28 , 29 , 30 ]. These factors, however, have failed to demonstrate a reproducible and significant association with increased risk of GFCS.…”

Microperipheral Iridectomy for Troublesome Posterior Synechiolysis in Secondary Intraocular Lens Implantation

“…Pediatric cataract is the leading cause of blindness in children, and timely cataract surgery is crucial for restoring vision. Following defects in the blood-aqueous barrier, the pediatric eye may develop severe postoperative inflammatory reactions, which may result in multiple complications, such as visual axis opacification [ 1 , 2 ], severe inflammatory response [ 3 , 4 ], formation of secondary membranes [ 3 ], intraocular lens (IOL) precipitates [ 5 ], pupillary capture [ 5 ], posterior synechiae [ 5 ], corectopia [ 6 ], glaucoma [ 1 , 7 ], endophthalmitis [ 6 ], and retinal detachment [ 8 , 9 ], among other conditions. Due to the inherent nature of the developing eyes and the narrow anterior ocular segment in children, not all pediatric patients can immediately receive IOL implantation after cataract surgery, particularly those aged <2 years [ 10 ].…”

Practice patterns in pediatric cataract management: Time for real world data

“…Pediatric cataract management has gained tremendous focus in the past decade. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ] There is a renewed sense that while cataract surgery in adults appears to be evolving at a furious pace that pediatric cataract surgery is perhaps lagging in our understanding of the basic physiological and anatomical issues that play a role in a successful outcome.…”

“…If we look at the numerous papers published on the subject of pediatric cataract, we begin to see that there have been numerous retrospective papers, survey data, one or two randomized control trials, some meta-analysis studies, and a Delphi consensus paper. [ 2 3 5 6 7 8 9 10 11 12 13 14 ] Do we indeed have enough data already to help answer some questions about pediatric cataract management? Maybe so but to develop RWD that leads to RWE the clinical question that we want to ask must be framed appropriately.…”

“…Consider that several authors from the Indian subcontinent,[ 6 7 8 ] USA and Asia[ 12 13 14 ] have published studies that counter the findings of IATS,[ 2 3 ] and that the only individual patient meta-analysis[ 9 ] contradicts other aspects of IATS. Given this nonconsensus and accepting that in IATS, the surgeon was allowed to change/modify the perioperative drug regimen including systemic steroid application,[ 2 ] which may or may not have influenced the amount of intraocular inflammation, one might want to change the clinical question from “Are IOL implants better for visual rehabilitation than aphakic correction in infants?” to two related questions: “In which infant eyes can intraocular implants be placed safely without excessive inflammation?” and “If infant eyes are safely implanted what is the visual outcome in these eyes compared to aphakic spectacle correction?”…”