Glaucoma after pediatric cataract surgery

ABSTRACT

To compare glaucoma after pediatric cataract surgery in children who did and children who did not undergo primary posterior chamber lens [PCIOL] implantation. Retrospective case series. An institutional retrospective chart review was performed of all patients who underwent pediatric cataract surgery with and without primary PCIOL implantation before the age of 12 years [from January 1985 to February 2003]; the review excluded microcornea and any condition independently associated with glaucoma. Patients had a minimum of 5 years [60 months] postoperative follow up, which had to include intraocular pressure measurements. The outcome measure was the presence or absence of post pediatric cataract surgery glaucoma, defined as persistently elevated intraocular pressure >/= 28 mmHg, as measured on at least 2 occasions with confirmation of the diagnosis by the treating ophthalmologist. A total of 489 pseudophakic eyes and 269 aphakic eyes met our inclusion criteria. Eight eyes [1.6%] out of the 489 pseudophakic eyes were diagnosed with glaucoma, whereas 62 eyes [23%] out of the 269 aphakic eyes were diagnosed with glaucoma. Mean age at time of surgery for the pseudophakic eyes was 45.6 months [standard deviation [SD] +/- 32.3] and for the aphakic eyes was 10.1 months [SD +/- 18.9]. Mean follow up period postoperatively was 70.4 months [SD +/- 12.5] and 123.7 months [SD +/- 66.2] in the pseudophakic and aphakic eyes respectively. The presence of postoperative complication [s] as well as the need for further intraocular surgery was risk factors for glaucoma development in the aphakic eyes. Glaucoma was diagnosed at an earlier onset in the pseudophakic eyes compared with the aphakic eyes [15.8 months +/- 18.8 vs 59.0 months +/- 44.0, P <0.0001]. Glaucoma control was more difficult in the aphakic eyes than in the pseudophakic eyes. Pseudophakic eyes had a significantly lower glaucoma incidence than aphakic eyes; however, because surgery was performed later in pseudophakic eyes we cannot conclude a protective effect from primary PCIOL implantation. Early age at cataract surgery as well as the presence of postoperative complication [s] and the need for further intraocular surgery [s] are risk factors for glaucoma development. Glaucoma after cataract surgery before 10 months of life tends to occur later and to be more difficult to control