Keywords
Lensectomy
Visual Axis Opacification
Secondary Glaucoma
Infant
How to Cite
Abstract
Objective: This study aimed to assess the frequency, timing, and types of postoperative complications following lensectomy in pediatric patients with congenital cataracts, and to investigate how complications varied across different cataract subtypes.
Methods: A retrospective study was conducted at Al-Shifa Trust Eye Hospital from January 2020 to December 2024, involving 154 pediatric patients under one year of age who underwent lensectomy with anterior vitrectomy. Postoperative complications were monitored for two years, with follow-up visits scheduled at specific intervals. Data were analyzed using descriptive statistics and chi-square tests.
Results: A total of 154 pediatric patients (mean age 8.0 ± 4.1 months) were included. Mature cataracts were the most common (66.2%), followed by nuclear (21.4%). Postoperative complications were observed at various time points, with the absence of complications ranging from 83.8% (n=129) on Day 1 to 96.8% (n=149) at Year 2. Anterior chamber inflammation peaked at 7.8% (n=12) on Day 1. Visual-axis opacification remained at 7.8% (n=12) from Month 1 to Month 12. Glaucoma increased gradually, reaching 3.9% (n=6) by Year 1. Other complications, such as shallow anterior chamber, peaked pupil, and endophthalmitis, were observed in fewer cases (≤3.9%). A significant association between cataract subtypes and postoperative complications was found (χ² = 12.45, p = 0.006).
Conclusion: Postoperative complications following lensectomy for congenital cataracts vary by cataract subtype and underscore the need for structured, interval-based follow-up. Early detection and prompt management, including additional surgical interventions, are critical to achieving optimal visual outcomes in pediatric patients.
Keywords: Cataract, Lensectomy, Secondary Glaucoma, Endophthalmitis
References
Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Cataracts. Lancet. 2017;390(10094):600–12. https://doi.org/10.1016/S0140-6736(17)30558-4
Tariq MA, Uddin QS, Ahmed B, Sheikh S, Ali U, Mohiuddin A. Prevalence of pediatric cataract in Asia: a systematic review and meta-analysis. J Curr Ophthalmol. 2022;34(2):148–59. https://doi.org/10.4103/joco.joco_157_21
Pichi F, Lembo A, Serafino M, Nucci P. Genetics of congenital cataract. Dev Ophthalmol. 2016;57:1–14. https://doi.org/10.1159/000443825
Shiels A, Hejtmancik JF. Inherited cataracts: Genetic mechanisms and pathways, new and old. Exp Eye Res. 2021 Aug;209:108662. https://doi.org/10.1016/j.exer.2021.108662
Lin H, Yang Y, Chen J, Zhong X, Liu Z, Lin Z, et al. Congenital cataract: prevalence and surgery age at Zhongshan Ophthalmic Center (ZOC). PLoS One. 2014;9(7):e101781. https://doi.org/10.1371/journal.pone.0101781
Khokhar SK, Pillay G, Dhull C, Agarwal E, Mahabir M, Aggarwal P, et al. Pediatric cataract. Indian J Ophthalmol. 2017 Dec;65(12):1340-1349. https://doi.org/10.4103/ijo.IJO_1409_17
Self JE, Taylor R, Solebo AL, Biswas S, Parulekar M, Dev Borman A, et al. Cataract management in children: a review of the literature and current practice across five large UK centres. Eye (Lond). 2020 Dec;34(12):2197-2218. https://doi.org/10.1038/s41433-020-0857-2
Trumler AA. Evaluation of pediatric cataracts and systemic disorders. Curr Opin Ophthalmol. 2011 Sep;22(5):365-79. https://doi.org/10.1097/ICU.0b013e32834df74d
Li H, Lin X, Liu X, Zhou X, Yang T, Fan F, et al. Surgical Outcomes of Lensectomy-Vitrectomy with Primary Intraocular Lens Implantation in Children with Bilateral Congenital Cataracts. Journal of Personalized Medicine. 2023 Jan 21;13(2):189. https://doi.org/10.3390/jpm13020189
Gupta P, Patel BC. Pediatric Cataract. PubMed. Treasure Island (FL): StatPearls Publishing; 2022.
Tartarella MB, Fortes Filho JB. Twenty-five-gauge sutureless lensectomy in infants with congenital cataract. J AAPOS. 2017 Oct;21(5):393–6. https://doi.org/10.1016/j.jaapos.2017.07.203
Oshika T, Endo T, Kurosaka D, et al. Long-term surgical outcomes of pediatric cataract—multivariate analysis of prognostic factors. Sci Rep 2023 ;13:21645. https://doi.org/10.1038/s41598-023-49166-2
Liu Y. Some lessons regarding intraocular implantation following pediatric cataract surgery. JAMA Ophthalmol. 2023; https://doi.org/10.1001/jamaophthalmol.2023.2672
Solebo AL, Rahi JS. Glaucoma following cataract surgery in the first 2 years of life: Frequency, risk factors and outcomes from IoLunder2. Br J Ophthalmol. 2020;104(7):967–73. https://doi.org/10.1136/bjophthalmol-2019-314519
Bothun ED, Repka MX, Kraker RT, Wu R, Leske DA, Hatt SR, et al. Incidence of glaucoma-related adverse events in the first 5 years after pediatric lensectomy. JAMA Ophthalmol. 2023;141(4):324–34. https://doi.org/10.1001/jamaophthalmol.2022.6543
Kuhli-Hattenbach C, Lüchtenberg M, Kohnen T, Hattenbach LO. Risk factors for complications after congenital cataract surgery without intraocular lens implantation in the first 18 months of life. Am J Ophthalmol. 2008 Jul;146(1):1–7.e1. https://doi.org/10.1016/j.ajo.2008.02.014
Solebo AL, Russell-Eggitt I, Cumberland PM, Rahi JS. Risks and outcomes associated with primary intraocular lens implantation in children under 2 years of age: The IoLunder2 cohort study. Br J Ophthalmol. 2015;99(10):1471–6. https://doi.org/10.1136/bjophthalmol-2015-307438
Freedman SF, Beck AD, Nizam A, Vanderveen DK, Plager DA, Morrison DG, et al. Glaucoma-related adverse events at 10 years in the Infant Aphakia Treatment Study: A secondary analysis of a randomized clinical trial. JAMA Ophthalmol. 2021;139(2):165–73. https://doi.org/10.1001/jamaophthalmol.2020.6094
Singh R, Barker L, Chen SI, Shah A, Long V, Dahlmann-Noor A. Surgical interventions for bilateral congenital cataract in children aged two years and under. Cochrane Database Syst Rev. 2022;2022(9).
Zhang B, Zhu M, Zhao Y. Postoperative complications of pediatric cataract surgery and their comparison between limbal and pars plana approaches: a meta-analysis. Arq Bras Oftalmol. 2025;88(4):e20240151. https://doi.org/10.5935/0004-2749.2024-0151.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2026 Aunaza Maqbool, Sorath Noorani, Rabia Faheem, Rabeeah Zafar, Shafaq Najmi, Najiah Uzair