One-third of Children Requiring Cataract Surgery Develop Visual Axis Opacification

This photo from another study shows inflammatory cell deposits (arrows) in a 3.5-year-old child with an implanted intraocular lens, posterior capsulorhexis and anterior vitrectomy. Photo: Petric I, Loncar V. Croatian Med J. 2004;45: 287-91. Click image to enlarge. Visual axis opacification (VAO) is a common postoperative complication that can occur after pediatric cataract surgery, resulting from inflammatory responses that induce lens epithelial cell proliferation and pupillary membrane formation. In a recent study, authors used data from the American Academy of Ophthalmology IRIS Registry to quantify the incidence of VAO following pediatric cataract surgery. They found that approximately one-third of children developed opacification affecting the visual axis within two years of cataract surgery, and those with a history of trauma or uveitis were most likely to develop VAO. The findings were reported in Ophthalmology.Included were 7,680 pediatric patients (age <19 years) who underwent cataract surgery between 2013 and 2020, split into an pseudophakia group (6,498) and an aphakia group (1,182). The median age was 11 and subjects had a median follow-up of 19.7 months. Demographic data included age at surgery (0 to <1, 1 to <3, 3 to <7, 7 to <12, 12 to <19 years), sex, laterality, race and ethnicity, insurance type and US Census region. Clinical factors included a history of ocular trauma, uveitis, retinopathy of prematurity (ROP) and performance of anterior vitrectomy.About one-third of children were diagnosed with VAO, and one-fourth were treated within two years of cataract surgery. Risk factors included older age and a history of trauma, uveitis or ROP. Pseudophakic children who did not undergo an anterior vitrectomy at the time of surgery were also more likely to develop VAO.A previous study reported a median six-month interval from surgery to VAO, with younger children affected earlier, a trend the authors of this current study also observed. “Herein, older age in the pseudophakic group without anterior vitrectomy were more likely to develop VAO,” the authors wrote in their Ophthalmology paper. “The rate of VAO among children under three years of age may be partially explained by the challenges of detecting VAO in very young children during routine clinical examinations.”Prematurity and low birth weight may contribute to cataract development, though the mechanisms are unclear. The authors found that children with a history of ROP were more likely to develop VAO, possibly due to perinatal factors or a propensity for fibrovascular proliferation.A history of uveitis or trauma was also associated with VAO. Among children with uveitis, VAO risk remained similar regardless of the type of uveitis, likely due to extensive inflammation and coexisting systemic diseases. “Consistent with previous studies that describe a relationship between ocular trauma and posterior capsular opacity formation, children with a history of trauma in our study were more likely to develop VAO, emphasizing the need for close monitoring in this population,” the authors explained in their paper.The researchers concluded with a recommendation that children at elevated risk for VAO—particularly those with a history of trauma, uveitis or ROP—should receive close follow-up and prompt intervention to prevent vision loss, particularly during the critical amblyogenic window.Click here for the journal source. Lee J-Y, Jeon JH, Altamirano F, et al. Visual axis opacification after pediatric cataract surgery in the IRIS Registry. Ophthalmology. June 20, 2025. [Epub ahead of print.]