Screening for glaucoma recommended after congenital cataract removal

Lifelong follow-up of patients after pediatric cataract surgery is needed to screen for the development of glaucoma, researchers suggest. A high incidence of glaucoma development was found after congenital cataract extraction in a review of more than 30 years’ worth of records at Harvard Medical School and Massachusetts Eye and Ear Infirmary.

Teresa C. Chen, MD, and colleagues in Boston reviewed the charts of all eyes seen by a pediatric glaucoma specialist from 1970 to 2002. They identified 170 eyes of 117 patients that had IOPs of greater than 25 mm Hg after undergoing lensectomy. Mean follow-up was 8.6 years. The two most common types of cataract were complete (40.8%) and nuclear (22.5%). Modern vitrectomy techniques were used for 103 of the lensectomy procedures, and 10 underwent the procedure with older techniques. Lensectomies were performed in 80.6% of the eyes before 1 year of age.

Glaucoma development was seen in 37.1% of the eyes in the first year after surgery, 75.9% by 6 years and 100% by 33 years. Of the eyes that underwent gonioscopy, 93.9% had open angles. Glaucoma surgery was needed in 57.1% of the eyes. The final median visual acuity was 20/400.

The study is published in the December issue of Archives of Ophthalmology.