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Study identifies risk factors for postop complications after congenital cataract surgery
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Young age, a family history of aphakic glaucoma, nuclear cataract and persistent fetal vasculature syndrome appear to be risk factors for extensive postoperative complications among pediatric patients undergoing cataract surgery, according to a study.
"Because complications such as aphakic glaucoma, secondary cataract formation or retinal detachment are associated with a worse visual prognosis, it is important to know which patients are at greatest risk for the development of these complications," Claudia Kuhli-Hattenbach, MD, told Ocular Surgery News in an interview.
Dr. Kuhli-Hattenbach and colleagues at Johann Wolfgang Goethe-University in Frankfurt, Germany, retrospectively reviewed the records of 71 eyes of 46 children aged 18 months and younger who underwent unilateral or bilateral congenital cataract surgery without IOL implantation between Aug. 1, 1996, and June 30, 2006. One surgeon performed a limbal approach bimanual lens aspiration, posterior capsulorrhexis and anterior vitrectomy on all patients.
During the procedure, the surgeon created a three-step entry to the anterior chamber using a limbal conjunctival incision, a scleral incision at 12 o'clock and a tunnel extending 1.5 mm to clear cornea. Initial entry into the anterior chamber was made using two paracenteses at 10 o'clock and 2 o'clock, after which the surgeon performed a continuous curvilinear capsulotomy of 5 mm to 5.5 mm with high-viscosity viscoelastic.
Three children were excluded from the analysis, leaving 65 eyes of 43 patients.
The most frequent postoperative complications were late-onset open-angle glaucoma (10.8%) and vitreous hemorrhage (10.8%); the incidence of early-onset glaucoma (4.6%) was less common.
The investigators observed secondary cataract formation in seven eyes (9.2%).
Strong predictors of late-onset glaucoma included a family history of aphakic glaucoma in first-degree relatives (P = .007), cataract surgery in the first 3 months of life (P = .039) and nuclear cataracts (P = .0009).
Secondary cataract formation was strongly associated with lensectomy in the first 5 months of life, according to the study.
In addition, a diagnosis of postop hemorrhages was significantly associated with the presence of persistent fetal vasculature (P < .0001).
"Because in our study postoperative vitreous hemorrhages cleared significantly in each case within 3 weeks, we recommend conservative management in children for the first postoperative weeks," Dr. Kuhli-Hattenbach said.
The study was published in the July issue of American Journal of Ophthalmology.