Postoperative Glaucoma Following Infantile Cataract Surgery

Abstract

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.

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

“…19 Despite varying definitions of glaucoma used in published studies, it is clear that a significant percentage of children undergoing congenital cataract surgery develop glaucoma (or at least elevated IOP), usually with open angles, and the onset of glaucoma frequently occurs years after cataract surgery. 1,2,6,7,22 …”

“…There is controversy surrounding the possible protective effect of primary IOL implantation (vs. aphakia) against glaucoma after cataract removal in infancy, with published reports both supporting 18,19 and failing to demonstrate this protective effect. 10,11 Trivedi et al noted that all glaucoma cases occurred in eyes having cataract surgery in the first 4.5 months of life, with similar rates in aphakic vs. pseudophakic eyes (19% vs. 24%, respectively).…”

“…10,11 Trivedi et al noted that all glaucoma cases occurred in eyes having cataract surgery in the first 4.5 months of life, with similar rates in aphakic vs. pseudophakic eyes (19% vs. 24%, respectively). 10 Mataftsi and colleagues, noted a protective effect of primary IOL vs aphakia in their large meta analysis (hazard ratio 0.1, p=0.02); 19 however, eyes were not randomized to primary IOL vs. aphakia, and a consistent definition of glaucoma was not applied. The IATS – by virtue of its randomization and prospective design – lacks the potential bias of prior non-randomized studies.…”

Exome sequencing identifies novel and recurrent mutations in GJA8 and CRYGD associated with inherited cataract

“…Congenital and infantile forms of cataract are a clinically important cause of impaired visual development that accounts for 3%-39% of childhood blindness, worldwide [4]. Despite advances in surgical treatment, pediatric cataract poses a long-term risk of postoperative complications including secondary glaucoma, nystagmus, and retinal detachment [5][6][7][8][9].…”

Our clinical experiences in paediatric cataract surgery

“…Mataftsi ve ark. yaptıkları çalışmada 470 olguyu ortalama 6 yıl takip etmişler ve 80 (%17) olguda ortalama 4.3 yıl sonra glokom geliştiği tespit edilmiştir (18). Chen ve ark.…”