Glaucoma-Related Adverse Events in the Infant Aphakia Treatment Study

Beck, Allen D.; Freedman, Sharon F.; Lynn, Michael; Bothun, Erick D.; Neely, Daniel E.; Lambert, Scott R.

doi:10.1001/archophthalmol.2011.347

Cited by 110 publications

(137 citation statements)

References 24 publications

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“…Interestingly, the odds of developing glaucoma or criteria that placed the eye in the IATS "glaucoma suspect" category were 3.1 times higher when mild PFV was present. The same study 10 noted a significantly higher rate of additional surgical procedures in the pseudophakic group, which our meta-analysis identifies as a glaucoma risk. This finding may explain the higher rate of glaucoma reported by the IATS group in children with pseudophakic eyes.…”

Section: Discussionsupporting

confidence: 65%

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Postoperative Glaucoma Following Infantile Cataract Surgery

et al. 2014

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IMPORTANCE Infantile cataract surgery bears a significant risk for postoperative glaucoma, and no consensus exists on factors that may reduce this risk.OBJECTIVE To assess the effect of primary intraocular lens implantation and timing of surgery on the incidence of postoperative glaucoma.DATA SOURCES We searched multiple databases to July 14, 2013, to identify studies with eligible patients, including PubMed, MEDLINE, EMBASE, ISI Web of Science, Scopus, Central, Google Scholar, Intute, and Tripdata. We also searched abstracts of ophthalmology society meetings.STUDY SELECTION We included studies reporting on postoperative glaucoma in infants undergoing cataract surgery with regular follow-up for at least 1 year. Infants with concurrent ocular anomalies were excluded. DATA EXTRACTION AND SYNTHESISAuthors of eligible studies were invited to contribute individual patient data on infants who met the inclusion criteria. We also performed an aggregate data meta-analysis of published studies that did not contribute to the individual patient data. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESTime to glaucoma with the effect of primary implantation, additional postoperative intraocular procedures, and age at surgery. RESULTSSeven centers contributed individual patient data on 470 infants with a median age at surgery of 3.0 months and median follow-up of 6.0 years. Eighty patients (17.0%) developed glaucoma at a median follow-up of 4.3 years. Only 2 of these patients had a pseudophakic eye. The risk for postoperative glaucoma appeared to be lower after primary implantation (hazard ratio [HR], 0.10 [95% CI, 0.01-0.70]; P = .02; I 2 = 34%), higher after surgery at 4 weeks or younger (HR, 2.10 [95% CI, 1.14-3.84]; P = .02; I 2 = 0%), and higher after additional procedures (HR, 2.52 [95% CI, 1.11-5.72]; P = .03; I 2 = 32%). In multivariable analysis, additional procedures independently increased the risk for glaucoma (HR, 2.25 [95% CI,; P = .01), and primary implantation independently reduced it (HR, 0.10 [95% CI, 0.01-0.76]; P = .03). Results were similar in the aggregate data meta-analysis that included data from 10 published articles. CONCLUSIONS AND RELEVANCEAlthough confounding factors such as size of the eye and surgeon experience are not accounted for in this meta-analysis, the risk for postoperative glaucoma after infantile cataract surgery appears to be influenced by the timing of surgery, primary implantation, and additional intraocular surgery.

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Section: Discussionsupporting

confidence: 65%

“…9,10 Although no statistically significant difference was found in the incidence of glaucoma between the aphakic and pseudophakic arms of the study at 12 months, results of a longer follow-up are expected to elucidate the aforementioned questions. These results may take several years, because postoperative glaucoma can have a delayed onset.…”

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confidence: 97%

Postoperative Glaucoma Following Infantile Cataract Surgery

et al. 2014

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“…26 Because elevation of intraocular pressure during infancy is known to cause ocular enlargement, these patients were excluded from the analyses (Table 1). We also excluded an eye from the analyses if either the baseline or age 1 year AL was not available because the A-scan tracing was missing, invalid, or unreadable.…”

Section: Patientsmentioning

confidence: 99%

Axial Elongation following Cataract Surgery during the First Year of Life in the Infant Aphakia Treatment Study

Lambert

Lynn

DuBois³

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To compare ocular axial elongation in infants after unilateral cataract surgery corrected with a contact lens (CL) or primary intraocular lens (IOL) implantation.METHODS. Baseline axial length (AL) was measured at the time of cataract surgery (1-6 months) and at age 1 year. AL at baseline and age 1 year and the change in length/mo were analyzed in relation to treatment modality, cataractous versus fellow eye, and age at surgery using linear mixed models.RESULTS. Mean baseline AL did not differ between the CL and IOL groups for either cataractous or fellow eyes. Eyes with cataracts were shorter than fellow eyes by an average of 0.6 mm (95% confidence interval [CI], 0.4-0.8 mm; P < 0.0001). For the operated eyes, the mean change in AL/mo was smaller in the CL group (0.17 mm/mo) than in the IOL group (0.24 mm/mo) (P ¼ 0.0006) and was independent of age at surgery (P ¼ 0.19). In contrast, the change in AL/mo for fellow eyes decreased with older age at surgery (P < 0.0001). At age 1 year, operated eyes treated with a CL were 0.6 mm shorter on average than operated eyes treated with an IOL (P ¼ 0.009).CONCLUSIONS. At baseline, eyes with cataracts were shorter than fellow eyes. The change in AL/mo was smaller in operated eyes treated with a CL than in operated eyes treated with an IOL, but was not significantly related to age at surgery. (ClinicalTrials. gov number, NCT00212134.) (Invest Ophthalmol Vis Sci. 2012; 53:7539-7545) DOI:10.1167/iovs.12-10285 O ne of the most challenging facets of implanting intraocular lenses (IOLs) during infancy is predicting the growth of the eye so that the desired refractive error can be achieved when the eye is fully grown. The infant eye elongates rapidly during the first year of life. 1,2 Both visual deprivation and optical defocus can alter ocular growth. 3,4 In addition, glaucoma during early childhood can cause excessive axial elongation.5 Postoperative refractive errors are usually corrected by spectacles or contact lenses. However, if the eye grows more than expected after IOL implantation, a large myopic refractive error may develop that in extreme cases may necessitate an IOL exchange.The effect of removing the crystalline lens on axial elongation during early childhood is poorly understood. [6][7][8][9][10][11][12] In a newborn rabbit model, a unilateral lensectomy has been shown to significantly decrease axial elongation. 13 A similar effect has also been observed using a nonhuman primate model. 14,15 The effect is age dependent, with the greatest effect occurring in neonates. 16 While some series have reported a reduction of axial elongation following cataract surgery and IOL implantation in children, others have reported increased axial elongation. 6,17,18 Furthermore, unilateral cataract surgery during infancy has been reported to be associated with more axial elongation in the operated eye than bilateral cataract surgery. 19,20 These effects have important clinical implications in determining the optimal IOL power to implant in a child to achieve the desired refr...

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“…Infant Aphakia Treatment Study indicate that delaying catract surgery from 4 to 8 weeks of age reduced the risk of glaucoma 1 year after surgery 50%. [20]. Also there was a three foldhig her incidence of glaucoma if cataract surgery was performed when an infant was 4-6 weeks of age compared to 7 weeks to 6 months of age [21].…”

Section: Discussionmentioning

confidence: 99%

Timing of Congenital Cataract Surgery from Different Aspects

Fatihoglu¹

2016

AOVS

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Congenital cataract is the most common cause of preventable childhood blindness worldwide. Early intervention can prevent prolonged visual deprivation which can cause deprivation amblyopia, nystagmus, strabismus and good visual outcomes can be achieved. However, it is known that early surgical intervention increases the risk of postoperative complications, especially the risk of secondary glaucoma. In this mini review we intended to evaluate the studies about optimum timing for congenital cataract surgery from different aspects.

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Glaucoma-Related Adverse Events in the Infant Aphakia Treatment Study

Cited by 110 publications

References 24 publications

Postoperative Glaucoma Following Infantile Cataract Surgery

Postoperative Glaucoma Following Infantile Cataract Surgery

Axial Elongation following Cataract Surgery during the First Year of Life in the Infant Aphakia Treatment Study

Timing of Congenital Cataract Surgery from Different Aspects

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