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Michelle Tarver, Michael X. Repka, Henry Silverman, Richard Domurat, Natasa Kordic, Thomas MaCurdy; Outcomes Associated with Cataract Surgery in the Pediatric Medicaid Population. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6763.
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Cataracts can have devastating visual consequences in children. Ophthalmologists may place an intraocular lens (IOL) during initial surgery despite the device not being FDA-approved for use in children. To explore the safety of this practice, we evaluated outcomes following cataract surgery with and without IOL placement in the pediatric Medicaid population.
All Medicaid beneficiaries enrolled January 1, 2000 to December 31, 2010 aged less than 22 years with International Classification of Disease (ICD-9) codes 36X, 379, 743, or 765 were eligible. Performance of cataract surgery with or without primary IOL placement was determined by Current Procedural Terminology (CPT) and ICD-9 procedure codes in a claims database. Outcomes were obtained from subsequent claims corresponding to the ICD-9 codes for retinal detachment, glaucoma, keratopathy, and posterior capsule opacification (PCO). Kaplan Meier curves, stratified by age, were used to assess the association between placement of an IOL and the outcomes of interest.
Of the approximately 34 million children enrolled in Medicaid during the study period, 2,559 underwent cataract surgery without IOL placement and 9,026 received an IOL during a 10 year period. In those without an IOL, 60% were younger than 5 years old, whereas over 70% of those who had an IOL placed were at least 5 years old. Children with an IOL placed were significantly less likely to have claims for retinal detachment over the 10 years of follow up (logrank, p<0.0001), with the pattern supported in age-stratified analyses. Keratopathy was less likely to be reported in those patients receiving an IOL at the initial surgery versus those without an IOL (logrank, p<0.001) but very few patients experienced this outcome. PCO was more common in those with an IOL than those without (35% versus 9%, p<0.001). While claims reporting glaucoma were more likely in those without an IOL compared to those with an IOL, this pattern was not consistent for all age strata nor statistically significant. In those children <1 year of age at cataract surgery, IOL placement was associated with a higher risk of having a claim for glaucoma in follow up, with most claims occurring within the first five years.
Insertion of an IOL at the time of cataract surgery does not increase the risk of retinal detachment or keratopathy in the pediatric population compared to not placing an IOL. While most children do not develop glaucoma after IOL placement, there may be an increased risk in infants. As expected, PCO was more common with IOLs. Our study is potentially limited if IOLs are preferentially placed in patients with healthier eyes. Further research should examine the effectiveness and safety of these devices in children.
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