Causes And Related Risk Factors Of Reoperations For Congenital Cataract Patients

Objective:To investigate the causes and related risk factors of reoperation after congenital cataract surgery and add surgery references for the treatment of congenital cataract.Methods:This was a retrospective study.From January 2009 to December 2018,congenital cataract patients in Qingdao Eye Hospital were collected and the incidences of reoperation were analyzed.Also,the reoperation times and causes were recorded and compared according to the age distribution(patients with scheduled intraocular lens implantation were excluded).The same type of phacoemulsification system and 25 G microvitrectomy systems were used for cataract surgery.Logistic regression was used to analyze the influence of different factors on the incidence of postoperative reoperation.The X2 test was used to analyze the relationship between the incidence of different causes of reoperation after cataract surgery and age and the effect of IOL implantation on reoperation.Results:A total of 870 children(1044 eyes)underwent congenital cataract extraction,the incidence of postoperative complications was 14.0%(146/1044),including posterior cataract,iris adhesion,secondary glaucoma,strabismus,ectopia of IOL,nystagmus,and retinal detachment.Among them,36 cases(42 eyes)were reoperated,with an incidence of 4.02%.Among the 36 cases,there were 28 male(34 eyes)and 8 female(8 eyes),6binocular reoperations,30 monocular reoperations,19 right eye reoperations,23 left eye reoperations.The corneal diameter was(9.52±1.11)mm,the axial length was(19.85±2.91)mm.The median age of cataract extraction was 4.3 months(range: 2.1 to 84 months),the median age of reoperation was 20.8 months(range: 3.8 to 106 months),and the median time between two operations was 5.75 months(range: 0d to 72.7 months).The top three causes for unscheduled reoperations were posterior capsule opacification(54.76%,23/42),secondary glaucoma(21.43%,9/42)and seclusion of pupil(14.29%,6/42),while others are mainly caused by ectopic intraocular lens(7.14%,3/42)and retinal detachment(2.38%,1/42).The incidence of reoperation was 13.29% in the group aged between 0 to 3months,3.82% for the group aged 4 to 12 months and 1.96% for group aged over 12 months.There was a significant difference between the groups(P<0.05).There was no statistically significant age-related difference in the incidence of reoperation in the 2 to 3years(3.52%),4 to 5 years(1.08%),and 6 to 7 years(3.51%)(P>0.05).One-stage Intraocular Lens Implantation can reduce the incidence of posterior capsule opacification and secondary glaucoma.There was a significant difference between the groups(P<0.05).Conclusions:Posterior capsule opacification,secondary glaucoma and seclusion of pupils are three main causes for reoperation of congenital cataract.Posterior capsule opacification is the primary reason for reoperation.Cataract surgery performed on patients aged less than3 month presents a higher reoperation incidence.The lower incidence of reoperation is found in children with primary intraocular lens implantation.It is suggested that congenital cataract surgery maybe not the earlier the better,and may need for comprehensive evaluation.