Retinal Detachment Following Pediatric Cataract Surgery Tied to Age, Prematurity

A population-based retrospective cohort study found that ~2% of pediatric patients who undergo cataract surgery will require retinal detachment (RD) surgical repair within 5 years of the procedure, according to findings published in Ophthalmology Science. The risk was higher in patients who were younger than 1 year at the time of cataract surgery and those who were born prematurely. 

Investigators at Boston Children’s Hospital and Harvard Medical School and Stanford University School of Medicine sourced data for this study from Optum’s Clinformatics Data Mart and IBM MarketScan Research Database which contained insurance claims collected in the United States between 2003-2021 and 2007-2016, respectively. Children (N=3289) who underwent cataract surgery at or before 18 years of age were evaluated for instances of and risk factors for subsequent RD surgical repair within 5 years of cataract surgery.

A total of 47 patients underwent RD surgical repair. In the RD and no RD cohorts, patients were aged 4.4±5.5 and 5.9±5.8 years at time of surgery, 62% and 51% were boys, 36% and 5.7% had persistent fetal vasculature (PFV; P <.001), fewer than 15 patients and 3.3% were born premature (P <.001), and 51% and 76% had intraocular lens placement (IOL; P <.001), respectively.

Overall, the rate of RD repair within 5 years of cataract surgery was 2.0% at a median time between procedures of 47 days. In adults, the rate of RD after cataract surgery is less than 1%, according to the investigators.

Need for RD surgical repair following pediatric cataract surgery was associated with PFV (hazard ratio [HR], 8.20; 95% CI, 4.11-16.37; P <.001), prematurity (HR, 6.89; 95% CI, 3.26-14.56; P <.001), and IOL placement (HR, 0.44; 95% CI, 0.21-0.91; P =.03).

Stratified by age at cataract surgery, the incidence of undergoing RD surgical repair was 4.1% among children aged younger than 1 year of age compared with 1.1% among those aged 1 year or older at cataract surgery.

This study may have been limited by excluding patients with traumatic cataracts.

These data indicated that among children undergoing cataract surgery, around 2% will require RD surgical repair within 5 years. “Our findings are consistent with prior studies reporting a higher incidence of RD after pediatric cataract surgery compared to adult cataract surgery,” according to the study authors “In addition, we identified a history of prematurity, PFV diagnosis and no IOL placement as risk factors for RD after adjusting for all covariates, including age at surgery. To our knowledge, our claims-based approach has identified the largest cohort of patients with RD following pediatric cataract surgery described in the literature to date.”