Glaucoma Considerations in Pediatric Cataract Surgery

Abstract

For patients with pediatric cataract, there has been a widely recognized correlation between glaucoma risk and patient age at the time of lensectomy. As a result, the best practice is to monitor children who undergo cataract surgery for glaucoma throughout their lives. The previous literature has shown variability in the reported rate and onset of glaucoma among children who undergo cataract surgery, but a general consensus has emerged from multiple studies that earlier intervention increases the risk of a child developing glaucoma or glaucoma suspect.Bothun et al 1 have strengthened this literature, adding to the weight of previous evidence with a new study on a sizeable cohort of patients with pediatric cataract. The authors have published a well-designed prospective longitudinal multicenter study that monitored children undergoing cataract surgery and examined the likelihood of developing glaucoma-related adverse events in relation to patient age at the time of surgery. The rigorous nature of the study design, including a total of 1049 eyes of 810 children with 5-year follow-up, provides compelling evidence that ophthalmologists can rely on to guide clinical practice and gauge patient risk. A key contribution of this work is to reduce the uncertainty regarding the specific glaucoma risk level for a patient with pediatric cataract, given a patient's age at the time of surgery and pseudophakic vs aphakic status.The authors have reported on glaucoma-related adverse events to include cases of both glaucoma and glaucoma suspect. The 5-year cumulative risk for developing glaucomarelated adverse events was 29% for aphakic eyes and 7% for pseudophakic eyes. Of this group, a smaller subset was diagnosed as glaucoma suspect with 7% for aphakic eyes and 3% for pseudophakic eyes. Among aphakic eyes, glaucoma-related adverse events were found to be more likely in patients younger than 3 months old at the time of surgery. Additionally, for aphakic eyes glaucoma surgeries were performed in 33 of 443 cases (7%), and pseudophakic eyes underwent glaucoma surgeries in 3 of 606 cases (0.5%). Aphakic eyes that required glaucoma surgery were in patients younger than 3 months old in 29 of 33 eyes (88% of cases). Other risk factors for aphakic eyes included abnormal anterior segments, bilateral cases, and intraoperative complications during lensectomy. Interestingly in this study, for pseudophakic eyes, bilateral cases and anterior vitrectomies were not

Through the Cat-Map Gateway: A Brief History of Cataract Genetics

“…Dense congenital and infantile cataracts that significantly reduce visual acuity during the critical period of visual development require early lens replacement surgery (under general anesthesia) with accurate refractive power correction within the first few months of life to avoid the risk amblyopia and loss of form vision [ 27 , 28 ]. While lens replacement surgery for congenital/infantile cataract provides the standard-of-care critical for a good visual outcome, it requires post-surgical monitoring for the development of glaucoma [ 29 , 30 ]. Recently, the introduction of lens regeneration surgery, which depends on in situ regrowth of the lens from endogenous lens epithelial ‘stem’ cells that are left largely intact following extraction of cataract material, has been proposed as an innovative surgical treatment for congenital/infantile cataract [ 31 , 32 ].…”