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Visual Acuity and Ophthalmic Outcomes 5 Years After Cataract Surgery Among Children Younger Than 13 Years

2022; American Medical Association; Volume: 140; Issue: 3 Linguagem: Inglês

10.1001/jamaophthalmol.2021.6176

2168-6173

Michael X. Repka, Trevano W. Dean, Raymond T. Kraker, Zhuokai Li, Kimberly G. Yen, Alejandra G. de Alba Campomanes, Marielle P. Young, Bahram Rahmani, Kathryn M. Haider, George F. Whitehead, Scott R. Lambert, Sudhi P. Kurup, Courtney L. Kraus, Susan A. Cotter, Jonathan M. Holmes, Sharon F. Freedman, David K. Wallace, Laura B. Enyedi, S. Grace Prakalapakorn, Sarah K. Jones, Denise Hug, Erin D. Stahl, Rebecca J. Dent, Lingkun Kong, Serena Wang, Bryan K. Gallerson, Amy K. Hutchinson, Phoebe D. Lenhart, Judy Brower, David G. Morrison, Scott T. Ruark, Rebecca Mets-Halgrimson, Hawke Yoon, Hantamalala Ralay Ranaivo, Aaliyah Hamidullah, Raymond G. Areaux, Jill S. Anderson, Ann M. Holleschau, Rosanne Superstein, Caroline Bélanger, Nicole Fallaha, Patrick Hamel, Maryse Thibeault, Susanna M. Tamkins, Ta Chen Chang, Hee-Jung S. Park, Anya A. Trumler, Xiaonong Liu, William F. Astle, Emi Sanders, Elias I. Traboulsi, Fatema F. Ghasia, Diana C. McOwen, Michael E. Gray, Michael B. Yang, Corey S. Bowman, Jennifer Galvin, Margaret Therriault, Heather Smith, Michele E. Whitaker, Faruk Örge, A. Paula Grigorian, Alicia M. Baird, Mitchell B. Strominger, Vicki Chen, Shelley Klein, Jacquelyn D. Kemmer, Alexandra E. Neiman, Myra N. Mendoza, Jill J. Frohwein, Don L. Bremer, Cybil Cassady, Richard P. Golden, Catherine O. Jordan, David L. Rogers, Sara A. Oravec, Tammy L. Yanovitch, Keven Lunsford, Christina Nye, Caroline Shea, SueAnn M. Stillman, Gaétan Laroche, Stephen C. Van Iderstine, Elisa Robertson, Oscar A. Cruz, Rafif Ghadban, Dawn Govreau, Scott A. Larson, Susannah Q. Longmuir, Xiaoyan Shan, Michael W. Clarke, Kate Taylor, Christine Powell, Benjamin P. Hammond, Matthew D. Gearinger, Andrea Czubinski, Dorothy Hendricks, Jing Jin, Jonathan Salvin, Alicia Fisher, Katherine A. Lee, Daniel Brooks, Bonita R. Schweinler, Nicholas A. Sala, Allyson M. Sala, Allison I. Summers, Daniel J. Karr, Lorri B. Wilson, Paula K. Rauch, Mary O’Hara, Nandini Gandhi, Tania Hashmi, Jeffrey Colburn, Eileen Dittman, Charles R. Whitfill, Amy M. Wheeler, Emily A. McCourt, Jasleen Singh, Nanastasia Welnick, Nathalie F. Azar, Joseph Baker, Patrick J. Droste, Robert J. Peters, Jan Hilbrands, Stacy L. Pineles, Marianne J. Bernardo, Edward Peterson, Charla H. Peterson, Kartik Kumar, Ephrem Melese, Robert W. Lingua, Jeff Grijalva, Earl R. Crouch, Earl R. Crouch, Gaylord Ventura, William Anninger, Shawn L. Benson, Karen A. Karp, Jordana M. Smith, Jill Brickman-Kelleher, Benjamin H. Ticho, Alexander J. Khammar, Deborah A. Clausius, Suquin Guo, Donny W. Suh, Carolyn Chamberlain, Susan Schloff, William P. Madigan, Donna Burkman, Stephen P. Christiansen, Jean E. Ramsey, Kate H. McConnell, Ilana Friedman, José Rosado, Donald P. Sauberan, Jody C. Hemberger, Patricia L. Davis, Indre Rudaitis, Robert S. Lowery, Shawn Cupit, Erick D. Bothun, Brian G. Mohney, Suzanne M. Wernimont, Rebecca A. Neilsen, Erin P. Herlihy, Francine Baran, Amy Gladstone, Justin Smith, Mei Mellott, Troy Kieser, S. Ayse Erzurum, Beth Colon, Birva Shah, Micaela Quebbemann, Roy W. Beck, Darrell S. Austin, Nicole M. Boyle, Courtney L. Conner, Danielle L. Chandler, Quayleen Donahue, Brooke P. Fimbel, Julianne L. Robinson, Amra Hercinovic, James E. Hoepner, Joseph D. Kaplon, Robert J. Henderson, Michele Melia, Gillaine Ortiz, Victoria C. Woodard, Kathleen M. Stutz, Desirae R. Sutherland, Rui Wu, Donald F. Everett, Marie Diener‐West, John D. Baker, Barry R. Davis, Dale L. Phelps, Stephen W. Poff, Richard Saunders, Lawrence Tychsen, Yasmin S. Bradfield, Nicole C. Foster, David A. Plager, Daniel J. Salchow, Eileen E. Birch, Ruth E. Manny, Jayne L. Silver, Katherine K. Weise, Lisa C. Verderber,

Ocular Infections and Treatments

Importance Cataract is an important cause of visual impairment in children. Data from a large pediatric cataract surgery registry can provide real-world estimates of visual outcomes and the 5-year cumulative incidence of adverse events. Objective To assess visual acuity (VA), incidence of complications and additional eye operations, and refractive error outcomes 5 years after pediatric lensectomy among children younger than 13 years. Design, Setting, and Participants This prospective cohort study used data from the Pediatric Eye Disease Investigator Group clinical research registry. From June 2012 to July 2015, 61 eye care practices in the US, Canada, and the UK enrolled children from birth to less than 13 years of age who had undergone lensectomy for any reason during the preceding 45 days. Data were collected from medical record reviews annually thereafter for 5 years until September 28, 2020. Exposures Lensectomy with or without implantation of an intraocular lens (IOL). Main Outcomes and Measures Best-corrected VA and refractive error were measured from 4 to 6 years after the initial lensectomy. Cox proportional hazards regression was used to assess the 5-year incidence of glaucoma or glaucoma suspect and additional eye operations. Factors were evaluated separately for unilateral and bilateral aphakia and pseudophakia. Results A total of 994 children (1268 eyes) undergoing bilateral or unilateral lensectomy were included (504 [51%] male; median age, 3.6 years; range, 2 weeks to 12.9 years). Five years after the initial lensectomy, the median VA among 701 eyes with available VA data (55%) was 20/63 (range, 20/40 to 20/100) in 182 of 316 bilateral aphakic eyes (58%), 20/32 (range, 20/25 to 20/50) in 209 of 386 bilateral pseudophakic eyes (54%), 20/200 (range, 20/50 to 20/618) in 124 of 202 unilateral aphakic eyes (61%), and 20/65 (range, 20/32 to 20/230) in 186 of 364 unilateral pseudophakic eyes (51%). The 5-year cumulative incidence of glaucoma or glaucoma suspect was 46% (95% CI, 28%-59%) in participants with bilateral aphakia, 7% (95% CI, 1%-12%) in those with bilateral pseudophakia, 25% (95% CI, 15%-34%) in those with unilateral aphakia, and 17% (95% CI, 5%-28%) in those with unilateral pseudophakia. The most common additional eye surgery was clearing the visual axis, with a 5-year cumulative incidence of 13% (95% CI, 8%-17%) in participants with bilateral aphakia, 33% (95% CI, 26%-39%) in those with bilateral pseudophakia, 11% (95% CI, 6%-15%) in those with unilateral aphakia, and 34% (95% CI, 28%-39%) in those with unilateral pseudophakia. The median 5-year change in spherical equivalent refractive error was −8.38 D (IQR, −11.38 D to −2.75 D) among 89 bilateral aphakic eyes, −1.63 D (IQR, −3.13 D to −0.25 D) among 130 bilateral pseudophakic eyes, −10.75 D (IQR, −20.50 D to −4.50 D) among 43 unilateral aphakic eyes, and −1.94 D (IQR, −3.25 D to −0.69 D) among 112 unilateral pseudophakic eyes. Conclusions and Relevance In this cohort study, development of glaucoma or glaucoma suspect was common in children 5 years after lensectomy. Myopic shift was modest during the 5 years after placement of an intraocular lens, which should be factored into implant power selection. These results support frequent monitoring after pediatric cataract surgery to detect glaucoma, visual axis obscuration causing reduced vision, and refractive error.