Glaucoma in aphakic and pseudophakic eyes following surgery for congenital cataract in the first year of life

Abstract

. Purpose: To determine the incidence and risk factors for glaucoma in pseudophakic and aphakic eyes following surgery for congenital cataract within the first year of life. Methods: We conducted a review of all cataract surgery performed at our unit over a 23‐year period. Age at surgery, corneal diameter, intraocular lens implantation, presence of persistent foetal vasculature and visual axis opacification (VAO) were documented. Time to development of glaucoma, management and outcome were determined. One eye was selected randomly for analysis in cases of bilateral cataract. Results: Duration of follow‐up was significantly longer (p < 0.001) in the aphakic (113 ± 69 months) compared to the pseudophakic group (56 ± 44 months). Age at surgery was significantly less (p = 0.01) in the aphakic group. The incidence of glaucoma was significantly greater (p = 0.02) in the aphakic (15 eyes, 33%) compared to the pseudophakic (seven eyes, 13%) group. Each eye that developed glaucoma underwent cataract extraction aged ≤ 2.5 months. Analysis of all eyes that underwent surgery aged ≤ 2.5 months revealed no statistical difference (p = 0.08) in the incidence of glaucoma. Smaller corneal diameter and VAO were not associated with increased risk of glaucoma development. Ahmed valves proved effective in controlling intraocular pressure but visual outcome was poor in the majority of cases. Conclusion: Surgery for congenital cataract at an early age increases the risk of glaucoma development, regardless of whether the eye is aphakic or pseudophakic. Intraocular pressure control with Ahmed valves is frequently required. Glaucomatous damage and dense amblyopia contribute to poor visual outcome in these eyes.

Incidence and predictors of glaucoma following surgery for congenital cataract in the first year of life in Victoria, Australia

“…Several studies have demonstrated a reduced incidence of glaucoma in pseudophakic compared with aphakic eyes . However, it is possible that the lower incidence represents a selection bias as patients with primary IOL insertion are more likely to be operated on after infancy when the risk of developing glaucoma may be much lower .…”

Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study

“…1–12 The Infant Aphakia Treatment Study (IATS) - a multi-center, randomized, controlled clinical trial sponsored by the National Eye Institute – compares outcomes of surgery for unilateral cataract with primary intraocular lens (IOL) implantation to surgery without IOL implantation in infants between 1 and 6 months of age. 13–17 …”

“…While some studies reported decreased glaucoma frequency among eyes with primary IOL implantation after cataract removal in the first year of life, 18–20 others noted a similar frequency, 1,10–12,21 but all lacked randomization regarding primary IOL placement.…”

Konjenital Katarakt Cerrahisi Sonrası Sekonder Glokom ve Risk Faktörleri

“…Bazı çalışmalarda glokom gelişimi ile mikrokornea arasında ilişki bulunmamış olmasına rağmen, 19 çok sayıda çalışmada önemli risk faktörü olarak gösterilmiştir. 2,3,13,16,18 Mikrokorneanın anterior segment yapısındaki anormalliğin ve gizli açı defektlerinin bir göstergesi olduğu, bu nedenle glokom riskini artırdığı öne sürülmektedir.…”

“…Çeşitli çalışmalarda primer GİL implantasyonu uygulanan olgularda, afak bırakılanlara göre daha düşük oranda glokom bildirilmektedir. 15,[19][20][21][22][23][24][25] Asrani ve ark. 15 377 psödofak gözde sadece 1 olguda, 124 afakik gözde ise 14 (%11,3) olguda glokom bildirmişlerdir.…”