Major article
Incidence and Risk Factors for Glaucoma After Pediatric Cataract Surgery With and Without Intraocular Lens Implantation

Presented in part at the 2005 AAPOS meeting in Orlando, Florida.
https://doi.org/10.1016/j.jaapos.2006.01.003Get rights and content

Purpose: We sought to report the incidence of glaucoma in the eyes of children who underwent cataract surgery with and without intraocular lens implantation and to report the risk factors for developing glaucoma. Methods: We undertook a retrospective review of pediatric cataract surgery charts, excluding traumatic cataract, aniridia and Lowe syndrome, steroid-induced cataract, lens subluxation, uveitis, retinoblastoma, radiation-induced cataract, retinopathy of prematurity, secondary IOL implantation, and patients with less than 1 month of postoperative follow-up. Results: After pediatric cataract surgery, 10 (3.8%) of 266 eyes with primary intraocular lens implantation were diagnosed with glaucoma, whereas 8 (17.0%) of 47 aphakic eyes were diagnosed with glaucoma. During the initial analyses, we noted that all of the patients who developed glaucoma underwent cataract surgery when they were 4.5 months or younger. For all patients who underwent surgery during the first 4.5 months of their life, the glaucoma incidence was 24.4% (10/41) in children with pseudophakic eyes and 19.0% (8/42) in age-matched children with aphakic eyes (risk ratio = 1.1, CI = 0.7–1.9; P = .555). In patients who underwent surgery during the first 4.5 months of their life, the average age of the patients who developed glaucoma was not significantly different than those who did not develop glaucoma in pseudophakic eyes (2.0 months ± 1.4 vs. 1.9 months ± 1.0, P = .700) or aphakic eyes (2.6 months ± 1.5 vs. 1.4 months ± 0.9, P = .070). The corneal diameter of the eyes that developed glaucoma versus eyes that did not was not significantly different in patients with pseudophakic eyes (P = .860) or aphakic eyes (P = .254). Glaucoma was diagnosed in patients at an average of 8.6 months and 117.9 months after cataract surgery in those with pseudophakic eyes and aphakic eyes, respectively. Conclusions: Patients undergoing cataract surgery at an early age are at high risk for the development of glaucoma with or without an intraocular lens implant.

Section snippets

Subjects and methods

A retrospective database review was performed for 470 consecutive eyes in patients that underwent pediatric cataract surgery with IOL implantation and 91 eyes in patients without an IOL implant between March 1991 and October 2004. Institutional review board approval was obtained to use our database for research purposes. The eyes of children with traumatic cataract, aniridia, Lowe syndrome, steroid-induced cataract, lens subluxation, uveitis, retinoblastoma, radiation-induced cataract,

Results

Two hundred sixty-six eyes with primary IOL implantation after cataract surgery were included in the primary analysis. Follow-up of these 266 eyes ranged from 1 to 145.6 months. During initial analysis, we noted that the 10 pseudophakic eyes that developed glaucoma underwent cataract surgery at 4.5 months of age or younger. The average follow-up in those children older than 4.5 months of age who underwent surgery was 40.8 months versus 43.2 months for those children who were 4.5 months or

Discussion

The incidence of glaucoma in children with aphakic eyes has been reported to be 5% to 41%.1, 3, 5, 6, 8, 15, 17, 18 However, the effect of IOL implantation on the incidence of glaucoma after cataract surgery is unclear. In a multicenter retrospective review, Asrani and coworkers23 reported a lower incidence (0.3%, or 1 in 377 cases) of open-angle glaucoma in eyes receiving a primary IOL implant compared with those that remained aphakic (11.3%, or 14 in 124 cases) after cataract surgery. In the

References (33)

Cited by (0)

Supported in part by NIH/NEI grant EY-14793; an unrestricted grant to MUSC from Research to Prevent Blindness, Inc., NY, NY; and the Grady Lyman Fund of the MUSC Health Sciences Foundation, Charleston, SC. The authors acknowledge the critical manuscript review of Luanna Bartholomew, Ph.D.

View full text