Pediatric cataract surgery had pooled complication incidences of 12% for visual axis opacification, 9.2% for reintervention, and 2.3% for secondary glaucoma, with shorter axial length increasing risk.
Meta-Analysis (n=5,290)
What are the incidences of major postoperative complications and their prognostic factors following pediatric cataract surgery?
Shorter axial length and primary IOL implantation are predictors of postoperative complications following pediatric cataract surgery, highlighting the need for careful surgical planning and long-term glaucoma surveillance.
We provide updated pooled estimates of the incidence of major postoperative complications after congenital or pediatric cataract surgery (visual axis opacification- VAO, VAO requiring reintervention, and secondary glaucoma) and identify clinical and surgical prognostic factors associated with these outcomes. A systematic search of PubMed, Scopus, and Web of Science was conducted. Studies reporting postoperative outcomes after pediatric cataract surgery were included. Pooled incidence rates were calculated using fixed- and random-effects models. Univariable and multivariable meta-regression analyses evaluated associations between outcomes and covariates including age at surgery, sex, anterior vitrectomy, primary intraocular lens (IOL) implantation, preoperative axial length (AL), and intraocular pressure. Eighty-seven studies (mean sample: 60.8 patients; 94.9 analysed eyes) met inclusion criteria. Under the random-effects model, pooled incidences (95% CI) were 12% (8%-16%) for VAO, 9.2% (6.0%-13.8%) for VAO requiring surgical reintervention, and 2.3% (1.3%-3.9%) for secondary glaucoma. Shorter preoperative axial length was significantly associated with higher risk of all three outcomes. Primary IOL implantation was independently associated with increased risk of VAO and reintervention, while anterior vitrectomy showed a significant association with secondary glaucoma in univariable analysis. Long-term postoperative visual acuity could not be meta-analyzed due to inconsistent reporting. We found that shorter AL and primary IOL implantation are predictors of postoperative complications following pediatric cataract surgery. These findings support careful surgical planning and highlight the need for standardized reporting and long-term follow-up, particularly for glaucoma surveillance.
Schiavetti et al. (Mon,) conducted a meta-analysis in congenital or pediatric cataract (n=5,290). pediatric cataract surgery was evaluated on incidence of major postoperative complications (visual axis opacification, VAO requiring reintervention, and secondary glaucoma). Pediatric cataract surgery had pooled complication incidences of 12% for visual axis opacification, 9.2% for reintervention, and 2.3% for secondary glaucoma, with shorter axial length increasing risk.