Frequency and Predictors of Retinal Detachment After Pediatric Cataract Surgery Without Primary Intraocular Lens Implantation

Purpose To determine the frequency and to identify predictors of retinal detachment after pediatric cataract surgery without primary intraocular lens implantation. Methods Retrospective review at an eye hospital identified 1017 eyes among 579 patients who underwent limbal-approach surgery without primary IOL implantation at age ≤16 years for cataract unassociated with other ocular abnormalities aside from microcornea. Patients had a minimum of 2 years postoperative follow-up. The outcome measure was the presence or absence of postcataract surgery retinal detachment, and analyses were performed on patients' eyes with adjustment for intrasubject correlation. Results Mean postcataract surgery follow-up was 6.8 ± 3.6 years (range, 2.0 to 18.3 years). Retinal detachment developed in 33 (3.2%) of the 1017 patients' eyes and was diagnosed at a mean of 6.8 ± 4.4 years postcataract surgery (range, 0.4 to 14.8 years). Multivariable Cox proportional hazards regression analysis with adjustment for intrasubject correlation identified an aphakic refractive error more myopic than the age-adjusted aphakic norm [hazard ratio (HR), 5.9; 95% confidence interval (CI), 1.9 to 18.0; P = 0.002] and postcataract surgery wound dehiscence (HR, 15.4; 95% CI, 2.2 to 108.5; P = 0.006) as predictors of retinal detachment; a primary posterior capsulotomy/anterior vitrectomy procedure was not predictive of retinal detachment. Conclusions Retinal detachment is infrequent following pediatric cataract surgery without primary IOL implantation, at least with short-term follow-up. A postoperative aphakic refractive error more myopic (less hyperopic) than the age-adjusted aphakic norm is predictive of this complication.