Risk Factors for Retinal Detachment Repair After Pediatric Cataract Surgery in the United States

PURPOSE: To determine the cumulative incidence of retinal detachment (RD) repair following pediatric cataract surgery and identify the associated risk factors. DESIGN: US population-based insurance claims retrospective cohort study. PARTICIPANTS: Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics (2003–2021) and IBM MarketScan (2007–2016). METHODS: Individuals with ≥ 6 months of prior enrollment were included, and those with a history of RD, RD repair, traumatic cataract, spherophakia, or ectopia lentis were excluded. The primary outcome was time between initial cataract surgery and RD repair. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), prematurity, intraocular lens (IOL) placement, and pars plana lensectomy approach. MAIN OUTCOME MEASURES: Kaplan–Meier estimated cumulative incidence of RD repair 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models. RESULTS: Retinal detachment repair was performed on 47 of 3289 children included in this study. The cumulative incidence of RD repair within 5 years of cataract surgery was 2.0% (95% CI, 1.3%–2.6%). Children requiring RD repair were more likely to have a history of prematurity or PFV and less likely to have an IOL placed (all P < 0.001). Factors associated with RD repair in the multivariable analysis included a history of prematurity (HR, 6.89; 95% CI, 3.26–14.56; P < 0.001), PFV diagnosis (HR, 8.20; 95% CI, 4.11–16.37; P < 0.001), and IOL placement (HR, 0.44; 95% CI, 0.21–0.91; P = 0.03). Age at surgery, sex, and pars plana lensectomy approach were not significantly associated with RD repair after adjusting for all other covariates. CONCLUSIONS: Approximately 2% of patients will undergo RD repair within 5 years of pediatric cataract surgery. Children with a history of PFV and prematurity undergoing cataract surgery without IOL placement are at the greatest risk.