Complications of cataract surgery in eyes with retinopathy of prematurity: a systematic review and meta-analysis.

PURPOSE: To characterize anatomic and visual outcomes following cataract extraction (CE) in eyes with a history of retinopathy of prematurity (ROP), with a primary focus on the risk of postoperative retinal detachment (RD). METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and the Cochrane Handbook. PubMed, Embase, and Scopus were searched through November 2025 for studies reporting outcomes after CE, with or without intraocular lens implantation, in eyes with a history of ROP. Risk of bias was assessed using ROBINS-I and certainty of evidence using GRADE. Pooled proportions of postoperative RD and final visual acuity were calculated using a random-effects model (DerSimonian-Laird). The Freeman-Tukey double arcsine transformation was applied for RD analyses due to zero-event studies. Subgroup analyses compared pediatric (< 18 years) and adult (≥18 years) CE outcomes. RESULTS: Seven studies published between 1995 and 2019 met inclusion criteria, comprising 108 eyes of 80 patients. The pooled proportion of postoperative RD across all ages was 0.0086 (95% CI, 0.0000-0.0765; I²=22.8%). In age-stratified analysis, the pooled RD proportion in pediatric eyes (40 eyes; 5 studies) was 0.0000 (95% CI, 0.0000-0.0031) and 0.1285 (95% CI, 0.0309-0.2661) among adult eyes (49 eyes; 3 studies), with no significant heterogeneity within subgroups. However, the difference between pediatric and adult subgroups did not reach statistical significance (p = 0.0525). Across the studies reporting visual acuity outcomes (55 eyes; 5 studies), the pooled proportion achieving final best-corrected visual acuity ≥ 20/200 was 0.5232 (95% CI, 0.3000-0.7375). Most studies were rated as serious risk of bias by ROBINS-I and overall certainty of evidence was very low by GRADE. CONCLUSION: Early postoperative RD after CE appears uncommon in pediatric eyes with ROP but may occur more frequently in adults with a history of ROP.