Factors Associated with Retinal Detachment Following Pediatric Cataract Surgery in the IRIS® Registry.

Abstract

Purpose: This study leverages the American Academy of Ophthalmology IRIS® Registry to identify factors associated with retinal detachment following pediatric cataract surgery.

Design: Retrospective cohort study.

Participants: All children (age <18 years) who underwent cataract surgery between January 2013 and December 2020 at practices that participate in the IRIS Registry.

Methods: Data collected included patient demographics and medical history. Current Procedural Terminology codes were used to identify procedures for cataract surgery and retinal detachment repair. International Classification of Disease codes were used to classify diagnoses such as degenerative high myopia, persistent fetal vasculature, retinopathy of prematurity, ocular trauma, and retinal detachment. The Kaplan-Meier estimator was used to determine the cumulative incidence of retinal detachment diagnosis and repair after cataract surgery. Hazard ratios with 95% confidence intervals were calculated using multivariable Cox regression models.

Main outcome measures: Cumulative incidence of retinal detachment diagnosis and repair within 5 years of cataract surgery.

Results: 7,407 children (53% male, 49% White non-Hispanic) were identified and included. The cumulative incidence of retinal detachment diagnosis and repair following cataract surgery was 3.8% (95% CI, 3.1%-4.5%) and 1.6% (95% CI, 1.2%-2.0%), respectively. Children with a history of ocular trauma (HR 2.22, 95% CI 1.39-3.57, P<0.001), aphakia (HR 2.10, 95% CI 1.43-3.10, P<0.001), premature retina (HR 2.73, 95% CI 1.36-5.48, P=0.005), persistent fetal vasculature (HR 3.26, 95% CI 1.58-6.71, P=0.001), and Hispanic ethnicity (HR 1.71, 95% CI 1.15-2.54, P=0.008) were at increased risk for developing retinal detachment diagnosis within 5 years of cataract surgery. Similar risk factors were identified for retinal detachment requiring surgical repair.

Conclusion: Among children undergoing cataract surgery in the IRIS Registry, retinal detachment was associated with a history of ocular trauma, aphakia, premature retina, persistent fetal vasculature, and Hispanic ethnicity. Identifying risk factors for complications following cataract surgery is essential to guide preoperative decision-making and long-term monitoring to mitigate retinal detachment risk in vulnerable patients.