Visual Outcomes And Complications After Lensectomy For Traumatic Cataract In Children

Importance The Pediatric Eye Disease Investigator Group Cataract Registry provides a multicenter assessment of visual outcomes and complications after lensectomy for traumatic pediatric cataract. Objective To report visual acuity (VA) and the cumulative proportion with strabismus, glaucoma, and other ocular complications by 15 months after lensectomy for traumatic cataract among children younger than 13 years at the time of surgery. Design, Setting, and Participants From June 18, 2012, to July 8, 2015, 1266 eyes of 994 children from 33 pediatric eye care practices seen within 45 days after lensectomy were enrolled in a multicenter, prospective observational registry. Of these, 74 eyes of 72 participants undergoing lensectomy for traumatic cataract were included in a cohort study. Follow-up was completed by November 2, 2015, and data were analyzed from March 20, 2018, to July 7, 2020. Exposures Lensectomy after ocular trauma. Main Outcomes and Measures Best-corrected VA from 9 to 15 months after lensectomy for traumatic cataract (for those 3 years or older) and the cumulative proportion with strabismus, glaucoma, and other ocular complications by 15 months. Results Of 994 participants in the registry, 84 (8%) had traumatic cataract. The median age at lensectomy for 72 participants examined within 15 months after surgery was 7.3 (range, 0.1-12.6) years; 46 (64%) were boys. An intraocular lens was placed in 57 of 74 eyes (77%). In children 3 years or older at outcome, the median best-corrected VA was 20/250 (range, 20/20 to worse than 20/800) in 6 eyes with aphakia and 20/63 (range, 20/20 to 20/200) in 26 eyes with pseudophakia. Postoperative visual axis opacification was reported in 18 of 27 eyes with pseudophakia without primary posterior capsulotomy (15-month cumulative proportion, 77%; 95% CI, 58%-92%). The cumulative proportion with strabismus was 43% (95% CI, 31%-58%) in 64 participants with ocular alignment data; exotropia was present in 14 of 23 participants (61%). The cumulative proportion with glaucoma was 6% (95% CI, 2%-16%). Conclusions and Relevance Trauma was not a common cause of pediatric cataract requiring surgery. For children with traumatic cataract, substantial ocular morbidity including permanent vision loss was found, and long-term eye and vision monitoring are needed for glaucoma, strabismus, and capsular opacification.This cohort study assesses visual acuity and the cumulative proportion with strabismus, glaucoma, and other ocular complications by 15 months after lensectomy for traumatic cataract among children younger than 13 years.Question What are the visual acuity outcomes and adverse events after surgery for traumatic cataract in children? Findings In this cohort study of 72 patients undergoing surgery for traumatic cataract, substantial vision loss due to trauma occurred by 15 months after surgery, with a median visual acuity of 20/63 in eyes with pseudophakia; strabismus was diagnosed in 23 cases (cumulative proportion, 43%, with exotropia in 14 [61%]) and glaucoma was diagnosed in 4 cases (cumulative proportion, 6%). In eyes with pseudophakia, visual axis opacification was diagnosed in 3 of 30 (cumulative proportion, 11%) with and 18 of 27 (cumulative proportion, 77%) without primary posterior capsulotomy. Meaning In this study, within 15 months after lensectomy for traumatic cataract in children, substantial ocular morbidity including permanent vision loss was common, suggesting the need for monitoring for development of strabismus and visual axis opacification.