A new large cohort study has shown that a third of intraocular lens (IOL) implants for nontraumatic glaucoma in children required reoperation for visual axis opacification (VAO) within 5 years, most often in eyes that did not have anterior vitrectomy. The study highlights the need for long-term monitoring of children with primary IOL implantation.
The study was conducted by the Pediatric Eye Disease Investigator Group (PEDIG) and involved 609 eyes of 491 children younger than 13 treated at 61 academic and community-based practices from June 2012 to July 2015. All the children had primary IOL implantation for nontraumatic cataract and no history of glaucoma. The primary outcomes were 5-year cumulative incidence of complications assessed by age at surgery and by IOL location. The patients had a mean age of 5.6 years, and boys accounted for 53% of the study population.
The results showed that 32% of the eyes developed VAO requiring reoperation after primary IOL implantation. The reoperation rate for VAO was 58% without anterior vitrectomy at the time of IOL implantation versus 12% with anterior vitrectomy. The incidence of reoperation for VAO did not differ significantly by age after adjustment for anterior vitrectomy.
Patients had a modest but clinically significant risk of glaucoma 5 years after surgery, which also did not differ by age. The data showed low 5-year rates for other types of complications, including corneal calcification (3%), retinal detachment (2%), peripheral anterior synechiae (<1%), posterior synechiae (1%), persistent intraocular inflammation (1%), surgically caused iris abnormalities (3%), endophthalmitis (<1%), and all others (1%).
The findings have substantial implications for clinical practice, particularly the findings related to VAO reoperation and subsequent glaucoma development. The results suggest that long-term follow-up is necessary, and that anterior vitrectomy at the time of IOL implantation may reduce the risk of VAO.
Primary IOL implantation has become increasingly common for older children, despite lack of FDA approval for use of the implants in children. As a result, there is limited data regarding long-term outcomes after IOL implantation in children. The study by PEDIG investigators sought to fill some of the data void by describing the type and frequency of complications occurring in the first 5 years after primary IOL implantation.
The study also suggests that additional complications associated with cataract surgery might occur in children with primary IOL implantation, but there was a low cumulative risk of serious complications, including retinal detachment and endophthalmitis 5 years after lensectomy.
The author of an accompanying editorial, Yizhi Liu, MD, PhD, of Sun Yat-Sen University in Guangzhou, China, noted that the study results are immediately useful to children (and their parents or guardians) who are considering cataract surgery, as well as to the pediatric ophthalmologists who are monitoring these children for complications after cataract surgery. He added that the study results suggest that long-term follow-up is necessary and that PEDIG should continue their research efforts in this area.
The study by PEDIG investigators highlights the need for long-term monitoring of children with primary IOL implantation, particularly those who did not have anterior vitrectomy at the time of IOL implantation. The study also suggests that additional complications associated with cataract surgery might occur in children with primary IOL implantation, but the risk of serious complications is low. The study results are immediately useful to children and their parents or guardians who are considering cataract surgery, as well as to pediatric ophthalmologists who are monitoring these children for complications after cataract surgery.