Amblyopia and aphakic correction are long recognized¹,² as the major issues in pediatric cataract surgery. Fortunately, vitreoretinal complications are uncommon after cataract surgery in children. However, when these complications occur, visual consequences can be devastating. Attention to modern vitreoretinal surgical principles can help the pediatric cataract surgeon minimize risks to the retina.

Endophthalmitis, while catastrophic, appears to be extremely uncommon³,⁴,⁵,⁶,⁷ in pediatric cataract surgery, with the best current estimate being <0.02%.⁶ When endophthalmitis is suspected, treatment decisions mirror those made in adult endophthalmitis, and there is no apparent etiologic disparity between children and adults compared to the endophthalmitis vitrectomy study.⁶,⁸

Cystoid macular edema (CME) occurs with unknown frequency after pediatric cataract extraction, in part due to the difficulty in detecting CME in the pediatric patient because of the challenges of performing macular examination, the inability to visualize CME with the indirect ophthalmoscope or RetCam, the sedation issues associated with fluorescein angiography, and the inability of children to position for ocular coherence tomography (OCT). Reports attempting to assess CME⁹,¹⁰,¹¹,¹²,¹³ have concluded that its occurrence in the pediatric population appears to be infrequent. If detected and visually significant, the treatment should therefore parallel guidelines for adult pseudophakic CME,¹⁴,¹⁵ including topical corticosteroids and nonsteroidal anti-inflammatory medications.

Retinal detachment can occur decades after what is thought to be uneventful cataract surgery.¹⁶,¹⁷,¹⁸,¹⁹,²⁰,²¹ The frequency of retinal detachment following pediatric cataract surgery varies among reports between 0.5% and 5%¹,²,²¹,²²,²³,²⁴

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