Delay surgery for congenital cataract until 1 month of age, researchers advise

Bilateral lensectomy during the first month of life is associated with a higher risk of subsequent glaucoma than surgery performed later, according to a British study. The study authors recommend delaying surgery for bilateral congenital cataract until the infant is at least 4 weeks old.

M. Vishwanath and colleagues at the Institute of Child Health in London reviewed the charts of all patients who had undergone lensectomy for congenital cataract during the first year of life from 1994 to 1997. Exclusion factors included Lowe syndrome, anterior segment dysgenesis and existing glaucoma.

A total of 128 lensectomies in 80 patients were performed during that time. Of those, nine eyes of six patients were lost to follow-up.

According to the researchers, the risk of developing glaucoma 5 years after the patient underwent lensectomy was 15.6% based on eye count. Just over 25% of patients developed glaucoma in at least one eye after bilateral surgery during the first 5 years postop. The incidence of glaucoma remained unchanged for the first 5 years postoperatively.

For infants who underwent bilateral lensectomy in the first month of life, the 5-year risk of glaucoma in at least one eye was 50%. In patients who underwent the procedure later, the risk was 14.9%. Visual outcomes were not affected by age at time of lensectomy, the authors said.

The study is published in the July issue of British Journal of Ophthalmology.