Background Pediatric cataract is a significant cause of childhood blindness globally, with visual axis opacification (VAO) being a leading and challenging postoperative complication.

Objective To evaluate the incidence and factors associated with visual axis opacification (VAO) following pediatric cataract surgery at KCMC Eye Department from January 2013 to January. 2023.

Methods A retrospective cohort study of 345 children (612 eyes) who underwent cataract surgery was conducted. Demographic and clinical data were collected from patient records. Data analysis was performed using STATA version 17. Kaplan-Meier survival curves assessed the probability of VAO over time. A Poisson regression model was used to identify factors associated with VAO, with significance set at P < 0.05.

Results Among 345 children, 189 (54.8%) were male, and 267 (77.4%) had bilateral cataracts. The median age at surgery was 28.5 months (range 9-72). Intraocular lenses were implanted in 519 (84.8%) eyes. The overall incidence of VAO was 19.9% (122/612), with an incidence rate of 0.251 per year. Secondary surgeries were performed in 20.3% (124/612) of eyes, mainly to clear the visual axis. Postoperatively, 69.4% of eyes had no visual impairment. Significant factors associated with VAO included age at surgery <60 months (AHR = 4.90; 95% CI: 2.77-8.70); P-value<0.001), surgical technique (LWO+IOL) (AHR = 7.58; 95% CI: 3.85-14.91); P-value<0.001), and postoperative acute fibrinous reaction (AHR = 5.91; 95% CI: 4.01-8.71); P-value<0.001).

Conclusion The incidence of VAO at KCMC is consistent with global data. Early age at surgery, surgical technique without PPC and AV, and postoperative inflammation were significantly associated with VAO. Adoption of preventive strategies and enhanced postoperative care are critical for improving visual outcomes.

The authors have declared no competing interest.

The author(s) received no specific funding for this work

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Ethical clearance was obtained from the Kilimanjaro Christian Medical University College (KCMUCo) Research and Ethics Committee (Ref: PG. 30/2023).

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