Pediatric Intraocular Lens Complications Not Linked With Age or Implant Location

Most often-occurring complication for children receiving IOLs may be visual axis opacification, but rarely endophthalmitis or retinal detachment.

The development of pediatric intraocular lens (IOL) complications in children who have undergone removal of nontraumatic cataracts is not associated with the patient’s age at implantation or the implant’s location, according to research published in JAMA Ophthalmology. Investigators with the Pediatric Eye Disease Investigator Group (PEDIG) reviewed cumulative incidence of glaucoma-related adverse events, retinal detachments, and endophthalmitis at 5 years postoperative.

The study included 609 eyes of 491 children younger than 13 years of age, with nontraumatic cataracts treated with lensectomy and primary unilateral or bilateral IOL implantation at 61 community and academic clinics between June 2012 to July 2015, with statistical analysis completed from September 2021 to January 2023. Eligibility required absence of baseline glaucoma.

The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring.

The most frequent pediatric intraocular lens complication involved visual axis opacification (VAO) and a need for VAO surgery.

VAO surgery occurred at a cumulative incidence of 32% (95% CI, 27% to 36%) — lower if IOL procedure and anterior vitrectomy were combined, 12% (95% CI, 8% to 16%); but higher without vitrectomy, 58% (95% CI, 50% to 65%). In fact, the hazard ratio (HR) to need surgery for VAO in the absence of vitrectomy was 6.19 (95% CI, 3.70 to 10.34, P <.001). In data adjusted for primary anterior vitrectomy, researchers found no large difference for having surgery according to age at implant (P =.74), or by lens location in the capsular bag or sulcus fixation (P =.75).

At 5 years, cumulative incidence of glaucoma suspect or glaucoma diagnosis proved to be 7% (95% CI, 4% to 9%), and did not vary by age group after statistical adjustment for lens location and unilateral or bilateral placement. “The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring,” according to the PEDIG. Severe pediatric intraocular lens complications are rare, the report shows.

Previous research demonstrated comparable glaucoma incidence for patients 1 year of age or older with lensectomy, although several studies focusing on infants found a higher glaucoma-related adverse event rate than the current analysis for children receiving unilateral or bilateral IOLs.

Limitations of this investigation included a small number of children less than 1 year of age receiving an IOL, a dearth of lens diversity, and substantial missing follow-up information.

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Yen KG, Repka MX, Sutherland DR, et al. Complications occurring through 5 years following primary intraocular lens implantation for pediatric cataractJAMA Ophthalmol. Published online June 22, 2023. doi:10.1001/jamaophthalmol.2023.2335