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Incidence et facteurs de risque de cataracte après vitrectomie par la pars plana dans la population pédiatrique

Pars plana vitrectomy can lead to cataract formation, reducing visual acuity and often requiring surgery. Cataract progression is common in adults but less so in younger individuals. Data on children are limited, and this study aims to explore cataract risk factors in the pediatric population.

Single centered, retrospective, consecutive case series. Information regarding demographic and ophthalmic features, surgical history and procedures were gathered and analyzed. Development of cataract requiring surgery was the main outcome measurement

242 eyes of patients (<18 years) that underwent lens-sparring pars plana vitrectomy with a minimum follow-up of 6 months were recruited and analysed. Mean age at surgery was 6.8±5.0 year and mean follow-up was 31.9±37.5 months. After a mean interval of 17.0 ± 22.0 months, 80 eyes (33.1%) required lensectomy with posterior subcapsular cataract being the most common cataract type (76.3%). Eyes that developed cataract were more likely to have undergone multiple surgeries (58.8% vs. 13.6%, p<0.001), needed silicone oil tamponade (76.3% vs. 10.5%, p<0.001), and were operated at an older age (101.9±53.1 months vs. 71.0±60.8 months, p<0.001). Retinal detachment was found to be associated with a higher risk of cataract development (78.8% vs. 19.1%, p<0.001). Multivariate analysis including the aforementioned variables identified the use of silicone oil [OR: 9.0 (CI: 2.8-28.9), p<0.001)] and the need for multiple surgeries [OR: 2.7 (CI: 1.2-6.2), p=0.02)] as predictors for the development post-pars plana vitrectomy cataract

This retrospective study evaluated cataract development in patients under 18 after lens-sparing pars plana vitrectomy. With a mean follow-up of 31.9 months, 33.1% required lensectomy. Silicone oil and gas tamponade followed by the need of multiple surgeries significantly increased cataract risk. Cataract incidence was lower than in adults, likely due to pediatric lens resilience. Limitations included retrospective design and potential follow-up bias. The study's strength was its large cohort and diverse etiologies.

Post-pars plana vitrectomy cataract is common complication occurring in about one-third of children. Risk factors include silicone oil tamponade and multiple surgeries. Follow-up should be started early and continued for an extended duration after pars plana vitrectomy especially in young children at risk of developing amblyopia.