Incidence and risk factors of rhegmatogenous retinal detachment following paediatric cataract surgery: A systematic review and meta-analysis.

Abstract

To determine the incidence and identify risk factors of rhegmatogenous retinal detachment (RRD) following paediatric cataract surgery. This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024538383). A comprehensive search was conducted across multiple databases, including Cochrane CENTRAL, PubMed/MEDLINE, SCOPUS, Web of Science, ScienceDirect and Google Scholar, up to December 2024. Studies were included if they reported on RRD following cataract surgery in paediatric populations (0-18 years) with a minimum follow-up of 4 months. Data extraction was performed independently by two authors, with disagreements resolved through consultation with a third author. Risk of bias was assessed using the Newcastle-Ottawa Scale, and statistical analysis was performed using R software version 4.5.0, with leave-one-out analysis conducted for outcomes with substantial heterogeneity (I² > 50%). The meta-analysis included data from 5922 eyes across nine studies. The mean age of the participants was 7.08 ± 3.13 years, with a mean follow-up duration of 4.02 years. The pooled incidence of RRD after paediatric cataract surgery was 2.4% [95% CI: 0.7%; 5.0%], with significant heterogeneity observed (I² = 85.8%). Patients without primary intraocular lens (IOL) implantation exhibited a numerically higher incidence of RRD (6.1% [95% CI: 0.6%; 15.9%]) compared to those with IOL implantation (1.9% [95% CI: 0.0%; 6.8%]); however, this difference was not found to be statistically significant (p = 0.2667). Similarly, the incidence of RRD was 1.0% [95% CI: 0.3%; 2.2%] in unilaterally operated eyes and numerically higher at 2.1% [95% CI: 1.0%; 3.6%] in bilaterally operated eyes, though this difference was also not statistically significant (p = 0.2563). Children with mental retardation demonstrated a significantly higher risk of RRD, with an incidence of 11.0% [95% CI: 6.6%; 16.4%]. Paediatric cataract surgery carries a notable risk of rhegmatogenous retinal detachment, with significant variability in incidence across different patient populations. While numerically higher incidences of RRD were observed in patients without primary IOL implantation and in bilaterally operated eyes compared to their counterparts, these differences did not reach statistical significance in this meta-analysis. The presence of mental retardation was identified as a significant risk factor. Enhanced postoperative monitoring and individualised surgical approaches are recommended, particularly for high-risk groups. Future research should focus on prospective studies with standardised protocols and longer follow-up periods to better understand causal relationships and refine preventive strategies.