Late-onset glaucoma following congenital cataract surgery: Occurrence, visual acuity and risk factors: A 37-year longitudinal follow-up.

PURPOSE: The aim of this study was to determine the prevalence of late-onset glaucoma after surgery for congenital cataract in a cohort with long-term follow-up and to evaluate visual development following the diagnosis of postoperative glaucoma in comparison with no glaucoma development. METHODS: All children born between 1980 and 1997 in the western counties of Sweden who had undergone congenital cataract surgery were included (patients n = 77, eyes n = 122). Cataract was considered congenital if there was no proof of clear lens at birth. Medical records were reviewed with regard to onset of glaucoma, age at surgery, surgical technique, coexisting eye anomalies and changes in visual acuity. Glaucoma was considered late onset if occurring after 1 year following surgery. RESULTS: Total glaucoma prevalence was 14.8%, including late (10.7%) and early onset (4.1%), with a mean follow-up of 23.2 ± 6.6 years. Microphthalmos was a significant risk factor for developing glaucoma (RR 7.75, p < 0.001). Bilaterally treated eyes had a mean visual acuity of 0.43 ± 0.33 (decimal value) at the last follow-up. With glaucoma, mean visual acuity was 0.19 ± 0.17 (decimal value). Treated eyes of patients with unilateral cataract surgery had a lower visual acuity. CONCLUSIONS: Life-long follow-up of all patients who have undergone surgery for congenital cataract in childhood is recommended. Annual check-ups of adults, including measurements of IOP and visual acuity, are recommended for patients with microphthalmos and/or who had surgery <3 months of age.

Evaluation of selective laser trabeculoplasty as an intraocular pressure lowering option.

PURPOSE: Selective laser trabeculoplasty (SLT) is one of the many treatment options for lowering intraocular pressure (IOP) in patients with glaucoma. This study aimed to evaluate the effect of SLT. METHODS: Data were collected from medical records of 289 patients who underwent SLT treatment (180° of trabecular meshwork) during 2014 and 2015 at the Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden. Baseline characteristics and information from a follow-up within 100 days were also recorded. The study analysed different subtypes of glaucoma with regard to SLT, with a particular focus on exfoliative glaucoma, a common subtype in Sweden. Successful treatment was defined as an IOP lowering effect of >20% with no further changes in treatment. The impact of surgeon's experience on treatment outcome was also analysed. RESULTS: Both patients with exfoliative glaucoma and those with primary open-angle glaucoma showed a reduction in mean IOP; no significant difference was found between these two subtypes before treatment or at the first follow-up. The success rate at follow-up (within 100 days) was 52%. There was a significant difference in outcome between surgeons with different levels of experience, but this difference could likely be explained by differences in treatment strategies and total energy used. CONCLUSION: For many patients with glaucoma, SLT was an effective treatment option for lowering IOP. It was also effective for several glaucoma subtypes. However, not all patients had a significant reduction in IOP after treatment with SLT, and some may require additional treatment.