Visual Outcomes and Complications Over 5 Years Following Lensectomy for Childhood Traumatic Cataract.
Document Type
Article
Publication Date
12-1-2025
Identifier
DOI: 10.1001/jamaophthalmol.2025.4121; PMCID: PMC12593669
Abstract
IMPORTANCE: The long-term outcomes of surgery for pediatric traumatic cataract are not well described; understanding these outcomes would inform parental expectations.
OBJECTIVE: To report visual acuity (VA) outcomes and cumulative incidence of ocular complications by 5 years following lensectomy for pediatric traumatic cataract.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted across 32 sites in the US and Canada among 75 children undergoing lensectomy from birth to less than 13 years of age for unilateral traumatic cataract. Of 75 children, 60 had primary intraocular lens (IOL) placement; 15 were left aphakic. Data were collected from August 2012 to February 2020. Data analysis was performed from October 2022 to May 2025.
EXPOSURE: Lensectomy.
MAIN OUTCOMES AND MEASURES: The primary outcomes were best-corrected VA 5 years after lensectomy; period prevalence of strabismus and glaucoma (including cases diagnosed before lensectomy); surgery for visual axis opacification (VAO); and cumulative incidence of ocular complications by 5 years. Annual data collection was from medical record reviews through 5 years following lensectomy.
RESULTS: Among 75 participants, 28 (37%) were female, and median (range) age at lensectomy was 7.4 years (0.1-13 years). Median (IQR) best-corrected VA at 5 years (available for 37 participants [49%]) was 20/63 (20/35-20/159) in pseudophakic eyes (n = 29; mean [SD] age at surgery, 7.2 [3.0] years) and 20/258 (20/56-< 20/800) in aphakic eyes (n = 8; mean [SD] age at surgery, 5.5 [4.3] years). Age-normal VA was achieved by 6 pseudophakic eyes (21%; 95% CI, 10%-38%) and 1 aphakic eye (13%; 95% CI, 2%-47%). The 5-year period prevalence of glaucoma was 9% in pseudophakic eyes (95% CI, 1%-16%) and 9% in aphakic eyes (95% CI, 0%-24%). The 5-year cumulative incidence of surgery for VAO was 47% in pseudophakic eyes (95% CI, 31%-60%) and 13% in aphakic eyes (95% CI, 0%-28%). The risk was greater in eyes that did not undergo an anterior vitrectomy (84%; 95% CI, 55%-94%) vs eyes that did (15%; 95% CI, 2%-26%) (age-adjusted hazard ratio, 11.4; 95% CI, 4.6-33.1; P < .001).
CONCLUSIONS AND RELEVANCE: In this cohort study, while only half of the study participants had a 5-year follow-up visit, achieving age-normal VA was uncommon among the cohort in whom a best-corrected VA was determined. The prevalence of glaucoma at 5 years was low among those with 5-year follow-up, while nearly half of the pseudophakic eyes needed surgery for VAO supporting the need to monitor these children.
Journal Title
JAMA Ophthalmol
Volume
143
Issue
12
First Page
1035
Last Page
1042
MeSH Keywords
Humans; Female; Male; Visual Acuity; Cataract Extraction; Child, Preschool; Infant; Child; Prospective Studies; Cataract; Postoperative Complications; Adolescent; Incidence; Follow-Up Studies; Lens, Crystalline; Infant, Newborn; Eye Injuries; Lens Implantation, Intraocular; Time Factors; Pseudophakia; Aphakia, Postcataract
PubMed ID
41196614
Keywords
Visual Acuity; Cataract Extraction; Prospective Studies; Cataract; Postoperative Complications; Incidence; Follow-Up Studies; Crystalline Lens; Eye Injuries; Intraocular Lens Implantation; Time Factors; Pseudophakia; Postcataract Aphakia
Recommended Citation
Stahl ED, Sutherland DR, Repka MX, et al. Visual Outcomes and Complications Over 5 Years Following Lensectomy for Childhood Traumatic Cataract. JAMA Ophthalmol. 2025;143(12):1035-1042. doi:10.1001/jamaophthalmol.2025.4121
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