Secondary glaucoma and visual axis opacification in aphakic and pseudophakic patients following congenital cataract surgery: A 28-year longitudinal case series

Abstract

Purpose: To determine the incidence, timing and risk factors for glaucoma and visual axis opacification development following surgery for congenital cataract in the first year of life. Methods: A prospective case series of all cataract surgery performed in Temple Street Children’s University Hospital over a 28-year period was conducted. A total of 93 subjects (135 eyes) were analysed. Sixty-two eyes had a primary intraocular lens inserted at the time of surgery; 73 eyes were aphakic. We recorded patient demographics, age at surgery, length of follow-up, rates and time to diagnosis of glaucoma and rates of visual axis opacification. Relative risk analysis was performed to identify potential risk factors for secondary glaucoma and visual axis opacification. Results: Mean length of follow-up was 160.02 ± 64.42 months (13.3 years), range 40–336 months. Final mean LogMAR across all groups was 0.85 ± 0.51 (0.90). Overall 45 (33.33%) eyes developed secondary glaucoma, 12 (19.4%) in pseudophakic eyes and 33 (45.21%) in aphakic eyes. The incidence of glaucoma was highest in bilateral aphakia (relative risk 1.96, p = 0.0240) and in eyes with corneal diameter <9.5 mm (relative risk 1.93, p = 0.0364). There was no significant difference in glaucoma rates between pseudophakia and aphakia in those operated on less than 2.5 months of age. Secondary glaucoma occurred between 3 months to 16.5 years post surgery. Rates of visual axis opacification were lower in aphakia compared to pseudophakia (relative risk 0.59, p = 0.0098). Conclusion: Overall glaucoma rates of one-third are similar to those recorded in the infantile aphakic treatment study. It can occur up to 17 years post cataract surgery, evidence that long-term follow-up is imperative.

Frequency of Pseudophakic Glaucoma in Patients with Cataract Surgery

“…Studies demonstrated that average duration of surgery was 2.5 years. 12,13 In the present study we found that the frequency of pseudophakic glaucoma was 32 (33.68%) while 63 (66.32%) patients had no glaucoma finding. Patients who received ECCE had high rate of glaucoma 28 (45.16%) as compared to phacoemulsification in 4 (12.12%) patients.…”

Intraocular Lenses for Infants With Aphakia

“…Of these potentially relevant articles, 176 publications were excluded for various reasons, and 33 publications met the inclusion criteria and were included in this report. These comprised 3 RCTs [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] and 15 nonrandomized studies, [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] relevant to research questions 1, 2, 3, and 4. No economic evaluations relevant to research questions 5 and 6 were identified. There were 16 clinical publications and 1 methods publication (which was not included in the overall count) 77 that reported on the same RCT -the Infant Aphakia Treatment Study (IATS).…”

“…The RCTs were conducted in the US [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]77 and India. 60,61 The nonrandomized studies were conducted in the US, [63][64][65] Germany, 66 Ireland, 67,68 UK, 69 Latvia, 70 China, 71 India, [72][73][74] France, 75 Brazil, 62 and Korea. 76 There were multiple publications for the IATS, which were published in 2020, 46,50,53 2016, 55,56 2015, 52,59 2014, 45,49,58 2013, 54,57 2012, 51 2011, 47,48 and 2010.…”

“…76 There were multiple publications for the IATS, which were published in 2020, 46,50,53 2016, 55,56 2015, 52,59 2014, 45,49,58 2013, 54,57 2012, 51 2011, 47,48 and 2010. 44 The years of publication for the remaining studies were 2021, 62 2020, 63,64,66,67,69,71 2019, 65 2018, 60 2017, 61,72,75 2016, 73 2014, 74,76 and 2010. 68 The studies were funded primarily by grants from organizations such as the National Eye Institute, [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]77 the American Society of Cataract and Refractive Surgery Foundation, 61 Mayo Clinic, 63 Research to Prevent Blindness, 64 National Institute for Health Research,…”

“…76 There were no funding sources for 5 studies. 60,67,70,74,75 Funding sources were not reported in 4 studies. 65,66,68,72 Study Design, Methods, and Settings…”