Prognostic factors and postoperative outcomes in pediatric cataract patients: A systematic review and meta-analysis.

We provide updated pooled estimates of the incidence of major postoperative complications after congenital or pediatric cataract surgery--visual axis opacification (VAO), VAO requiring reintervention, and secondary glaucoma--and identify clinical and surgical prognostic factors associated with these outcomes. We conducted a systematic search of PubMed, Scopus, and Web of Science. Studies reporting postoperative outcomes after pediatric cataract surgery were included. Pooled incidence rates were calculated using fixed- and random-effects models. Univariable and multivariable meta-regression analyses evaluated associations between outcomes and covariates including age at surgery, sex, anterior vitrectomy, primary intraocular lens (IOL) implantation, preoperative axial length (AL), and intraocular pressure. Eighty-seven studies (mean sample: 60.8 patients; 94.9 analysed eyes) met inclusion criteria. Under the random-effects model, pooled incidences (95% CI) were 12% (8%-16%) for VAO, 9.2% (6.0%-13.8%) for VAO requiring surgical reintervention, and 2.3% (1.3%-3.9%) for secondary glaucoma. Shorter preoperative axial length was significantly associated with higher risk of all 3 outcomes. Primary IOL implantation was independently associated with increased risk of VAO and reintervention, while anterior vitrectomy showed a significant association with secondary glaucoma in univariable analysis. Long-term postoperative visual acuity could not be meta-analyzed due to inconsistent reporting. We found that shorter AL and primary IOL implantation are predictors of postoperative complications following pediatric cataract surgery. These findings support careful surgical planning and highlight the need for standardized reporting and long-term follow-up, particularly for glaucoma surveillance.