Risk Factors Of Early-Onset Visual Axis Opacification In Congenital Cataract Surgery: A Ccmpoh Report

Purpose: To investigate the risk factors of early-onset visual axis opacification (VAO) development within 3 months after congenital cataract surgery.

Design: Retrospective analysis of prospectively collected data from the Childhood Cataract Program of the Chinese Ministry of Health (CCPMOH).

Participants: A total of 317 eyes from 193 patients (aged ≤ 2 years) with congenital cataract were recruited, nested in the CCPMOH cohort.

All eyes underwent a standard congenital cataract surgery. The IOL were not implanted primarily. Early-onset VAO was defined as the presence of visually significant opacifications causing a dull retinoscopy reflex and difficulty in retinal monitoring within 3 months postoperatively. Abnormal iris characteristics (AIC) were identified by an unrecognizable iris collarette and crypts, short contraction rings and unclear iris texture. A mixed effects model was used to explore the association of potential risk factors with VAO, including demographic and biometric parameters, AICs, types of lens opacity, and ocular comorbidity. The results of risk factors were presented as odds ratio (OR) and its 95% confidence interval (CI).

Results: The incidence of early-onset VAO was 25.9% (82 out of 317 eyes), occurring on average 44.5 ± 22.6 days postoperatively. In multivariate model, cataract surgery before 6 months of age (OR=0.07, 95%CI: 0.06, 0.19; P=0.02), AIC (OR=0.14, 95%CI: 0.02, 0.25; P=0.02), and membranous cataracts (OR=0.21, 95%CI: 0.05, 0.37; P=0.01) were found to be associated with the incidence of early-onset VAO.

Conclusions: Surgery before 6 months, AIC and membranous cataract were main risk factors for early-onset VAO after congenital cataracts. These findings emphasize the need for heightened vigilance strategies for susceptible individuals.