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

Abstract

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.

Predictors of Glaucoma After Pediatric Cataract Surgery

“…6,7 Reported frequency and risk factors for having GFCS vary according to study population, definition, and follow-up time, in a multitude of prospective and retrospective studies that have already been published on this topic. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Nonetheless, as reported in the Ninth Consensus Meeting of Childhood Glaucoma of the World Glaucoma Association, young age at the time of cataract surgery and microcornea consensually increase the risk of GFCS. 24 Typically, age <12 weeks at surgery is considered the critical timing.…”

“…24 These secondary glaucoma cases typically present an open angle 12,23,24 and develop in a bimodal pattern, either in the first year after surgery 16 or several years after surgery. 10,14 Recently, one study with a mean follow-up of 23 years after surgery reported a glaucoma prevalence of 15%, including late (10.7%) and early onset (4.1%), thus recommending life-long follow-up of all patients who have undergone surgery for congenital cataract in childhood. 10 Age at lensectomy is considered a significant modifier of the risk of development of GFCS after cataract surgery, 9,10,13,16,17,26 being the strongest marker of ocular "maturity."…”

“…10,14 Recently, one study with a mean follow-up of 23 years after surgery reported a glaucoma prevalence of 15%, including late (10.7%) and early onset (4.1%), thus recommending life-long follow-up of all patients who have undergone surgery for congenital cataract in childhood. 10 Age at lensectomy is considered a significant modifier of the risk of development of GFCS after cataract surgery, 9,10,13,16,17,26 being the strongest marker of ocular "maturity." 17 To date, there is no universally accepted explanation for the etiology of GFCS.…”

“…22 Other studies found that the risk of GFCS is higher when surgery is performed before 12 weeks of age. 9,10,19 Other predictors of the risk of development of GFCS are more debatable. Ocular size, more specifically, AL and cornea diameter have independently predicted the risk of GFCS in some studies, 14,15,17 but failed to do so in others, 13 mainly because age at surgery may be a confounding variable for ocular dimensions, as there is a natural correlation between age at surgery, corneal diameter and AL.…”

“…Age at surgery was analyzed as both a continuous and a categorical variable ( ≤ 12 wk of age at surgery vs > 12 wk of age at surgery, ≤ 16 wk of age at surgery vs > 16 wk of age at surgery, and ≤ 28 wk of age at surgery vs > 28 wk of age at surgery) anchored in clinically relevant milestones. 9,10,13,19 When comparing patients who underwent unilateral surgery with patients who underwent bilateral cataract surgery, one eye per patient was randomly selected from the latter group. Variables assessed as potential risk factors for glaucoma comprised: (1) sex, (2) eye laterality (right vs left eye), (3) cataract laterality (unilateral vs bilateral), (4) age at surgery, (5) horizontal corneal diameter, both as a continuous variable and categorized into microcornea (horizontal diameter <9.5 mm) or normal corneal diameter, (6) presence of PFV, (7) presence of other AS abnormalities, (8) primary IOL implantation, (9) intraoperative complications, and (10) need for and the number of reinterventions.…”