Management of Childhood Glaucoma Following Cataract Surgery

Abstract

Glaucoma remains a frequent serious complication following cataract surgery in children. The optimal approach to management for ‘glaucoma following cataract surgery’ (GFCS), one of the paediatric glaucoma subtypes, is an ongoing debate. This review evaluates the various management options available and aims to propose a clinical management strategy for GFCS cases. A literature search was conducted in four large databases (Cochrane, PubMed, Embase, and Web of Science), from 1995 up to December 2021. Thirty-nine studies—presenting (1) eyes with GFCS; a disease entity as defined by the Childhood Glaucoma Research Network Classification, (2) data on treatment outcomes, and (3) follow-up data of at least 6 months—were included. Included papers report on GFCS treated with angle surgery, trabeculectomy, glaucoma drainage device implantation (GDD), and cyclodestructive procedures. Medical therapy is the first-line treatment in GFCS, possibly to bridge time to surgery. Multiple surgical procedures are often required to adequately control GFCS. Angle surgery (360 degree) may be considered before proceeding to GDD implantation, since this technique offers good results and is less invasive. Literature suggests that GDD implantation gives the best chance for long-term IOP control in childhood GFCS and some studies put this technique forward as a good choice for primary surgery. Cyclodestruction seems to be effective in some cases with uncontrolled IOP. Trabeculectomy should be avoided, especially in children under the age of one year and children that are left aphakic. The authors provide a flowchart to guide the management of individual GFCS cases.

Outcomes of Goniotomy With or Without Secondary Intraocular Lens Implantation in Pediatric Glaucoma Following Cataract Surgery: A Prospective Pilot Study

“…The management of GFCS is notoriously challenging as it is often recalcitrant to treatment 20 . Medical therapy is the first-line treatment, yet a significant portion of cases are refractory to medical therapy alone and the largest cohorts reported a variable success rate of 41%–73% 21 . According to the literature, surgical intervention is required in up to 83% of GFCS cases, 21 whereas the optimal surgical approach and strategy in GFCS remains controversial.…”

“…Medical therapy is the first-line treatment, yet a significant portion of cases are refractory to medical therapy alone and the largest cohorts reported a variable success rate of 41%–73% 21 . According to the literature, surgical intervention is required in up to 83% of GFCS cases, 21 whereas the optimal surgical approach and strategy in GFCS remains controversial. Trabeculectomy, despite the adjunctive use of potent antimetabolites, is known to have a high odds of failure in aphakic glaucoma eyes 22,23 .…”

Efficacy of microcatheter-assisted trabeculotomy on secondary glaucoma after congenital cataract surgery

“…And the most important way to reduce IOP is surgery, with medications being useful as temporizing measures or adjunctive treatment. Meanwhile, surgical options include angle surgery, filtering surgery, glaucoma drainage devices, and cyclodestructive procedures [12][13][14] . However, due to the strong metabolic and repair ability of children, glaucoma drainage device implantation and traditional filtering surgery may increase the risk of scar formation by organized filtration channels.…”

It Is All about Pressure

“…Glaucoma is more prevalent in adults; however, IOP elevation can also be found in younger age groups. The study entitled "Management of childhood glaucoma following cataract surgery" is a review that evaluates the different treatment options and clinical management strategies reported in current literature for children with glaucoma following cataract surgery [25]. The various therapeutic approaches include medical therapy, angle surgery, glaucoma drainage device implantation, trabeculectomy, and cyclodestructive procedures.…”