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Persistent fetal vasculature may increase risk for glaucoma in infants who undergo cataract surgery
Younger age at surgery also increased risk for later glaucomatous changes.
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Glaucoma is a known complication after cataract surgery in young patients, and the presence of persistent fetal vasculature, or PFV, increases the risk for glaucomatous changes in those patients, according to a study. Furthermore, younger age at surgery, with or without placement of an IOL, also increases risk for early development of glaucoma.
“We investigated the effect of age at surgery, corneal diameter, a diagnosis of PFV, preoperative IOP, and additional surgery performed after cataract surgery on the development of a glaucoma-related adverse event,” Allen D. Beck, MD, and colleagues wrote in Archives of Ophthalmology about the 1-year results of the Infant Aphakia Treatment Study (IATS).
Study results
IATS is an ongoing multicenter, randomized, controlled clinical trial intended to compare visual outcomes in infants who receive an IOL or a contact lens after surgical extraction of a unilateral congenital cataract. This report concentrates on glaucoma-related adverse events that may develop in these patients through 1 year of follow-up.
Of 114 infants with unilateral congenital cataract who underwent surgery between 1 month and 6 months of age, 57 were randomized to the IOL group and 57 to the contact lens group.
One year postoperatively, 10 patients developed glaucoma and four were identified as glaucoma suspects. Nine patients in the IOL group developed a glaucoma-related adverse event compared with five patients in the aphakic group. Infants with PFV, however, were at a 3.1 times higher risk of developing a glaucoma-related adverse event, according to the study.
“There was no sign of glaucoma in the infants in this study prior to undergoing surgery,” Dr. Beck told Ocular Surgery News. “The development of glaucoma is a postoperative phenomenon, but one that is treatable.”
Take-home points
The study results are preliminary.
“With our 1-year results, we realize the risk of glaucoma development in these children seems to increase as they get older. Many of them were diagnosed with glaucoma at 4, 5 and 6 years of age post-congenital cataract surgery,” Dr. Beck said.
Even with close monitoring, glaucoma is unavoidable, he said. The congenital factors and the very young patient age are major risk factors in the development of glaucoma, and PFV contributes to the development of adverse glaucomatous events.
Dr. Beck proposed a proactive follow-up examination of these patients as they age. He suggested that a 5-year follow-up and 5-year outcomes study are warranted. – by Sara E. Olson
Reference:
- Beck AD, Freedman SF, Lynn MJ, Bothun E, Neely DE, Lambert SR; for the Infant Aphakia Treatment Study Group. Glaucoma-related adverse events in the Infant Aphakia Treatment Study: 1-year results. Arch Ophthalmol. 2012;130(3):300-305.
For more information:
- Allen D. Beck, MD, can be reached at Emory Eye Center, The Emory Clinic, Building B, 1365B Clifton Road, N.E., Atlanta, GA 30322; 404-778-5416; email: abeck@emory.edu.
- Disclosure: Dr. Beck has no relevant financial disclosures.