Be especially vigilant for signs of glaucoma in pediatric patients with congenital cataract.
Be especially vigilant for signs of glaucoma in pediatric patients with congenital cataractPhoto: Joseph W. Sowka, OD. Click image to enlarge.

A study assessing the visual outcomes of children who underwent lensectomies for childhood cataract recently reported that glaucoma development or suspicion was a common finding in children after five years, as well as a modest myopic shift.

The prospective study analyzed data of 994 children (1,268 eyes) from the Pediatric Eye Disease Investigator Group clinical research registry (UK, US and Canada). Many participants were lost to follow-up; 66% were seen in the fifth year with varying outcomes (Table 1).

Within five years, the researchers reported glaucoma-related adverse events in 14% of eyes and retinal detachment in 2%. Additional intraocular surgery was required in 33%, most commonly for clearing the visual axis (29%) or to implant a secondary IOL (10%). The researchers reported no unexpected adverse events.

“Although good visual acuity was possible after cataract surgery in children from birth to less than 13 years of age, age-normal vision was uncommon,” the researchers wrote in their paper. In addition to glaucoma development, they noted frequent amblyopia. Though refractive error was “tightly clustered around emmetropia,” they wrote that the shift should be factored into implant power selection.

Table 1. Five-year Outcomes After Bilateral or Unilateral Pediatric Lensectomy

% Achieved (median visual acuity)


Cumulative incidence of glaucoma or glaucoma suspect (%)

Cumulative incidence of clearing visual axis (%)

% Achieved (Median change in spherical equivalent refractive error (D))

Bilateral aphakic

58 (20/63)



28 (-8.38)

Bilateral pseudophakic

54 (20/32)



34 (-1.63)

Unilateral aphakic

61 (20/200)



21 (-10.75)

Unilateral pseudophakic

51 (20/65)



31 (-1.94)

Repka MX, Dean TW, Kraker RT, et al. Visual acuity and ophthalmic outcomes 5 years after cataract surgery among children younger than 13 years. JAMA Ophthalmol. February 10, 2022. [Epub ahead of print].