Incidence of postoperative retinal detachment and bacterial endophthalmitis in the Swedish national paediatric cataract register and associated risk factors.

Purpose: To investigate the incidence and risk factors of retinal detachment (RD) and bacterial endophthalmitis in a cohort of children who underwent cataract surgery before the age of eight.

Methods: Data was retrieved from the Swedish national paediatric cataract register. All eyes with congenital or infantile cataract that underwent surgery between January 1, 2007, and December 31, 2023 with at least one follow-up were included. Cases associated with trauma, uveitis or RD at surgery were excluded. Parameters that could be important for complications were analysed.

Results: RD was found in seven of 1073 eyes reflecting an incidence of 0.65%. There were no statistically significant differences in age at surgery, presences of intellectual disability or general disease, cataract type, surgical technique, axial length, corneal diameter, previous glaucoma surgery or occurrence of persistent fetal vasculature (PFV), although the frequency of glaucoma surgery and PFV was higher in RD cases; 42.9% versus 13.2% and 57.1% versus 26.0%. Aphakia was significantly more common in RD patients; 71.4% versus 19.3% (p = 0.042), as well secondary glaucoma; 57.1% versus 19.5% (p = 0.032). No cases of endophthalmitis were observed.

Conclusion: The incidence of RD was low compared to previous studies and no endophthalmitis was found. This might be a result of centralized paediatric cataract care with few but experienced surgeons. Aphakia and secondary glaucoma were associated with higher RD risk and those cases should be followed carefully. PFV and glaucoma surgery were found at a higher frequency in RD cases prompting comprehensive postoperative care also for these children.