Glaucoma a common complication after pediatric cataract surgery
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Secondary glaucoma was a common complication with bimodal incidence following pediatric cataract surgery, according to a study published in the American Journal of Ophthalmology.
“Despite advances in congenital cataract management, secondary glaucoma (SG) remains a major postoperative sight-threatening complication, with open angle glaucoma being the predominant type in both aphakic and pseudophakic children,” Youssef Abdelmassih, MD, pediatric ophthalmology department at the Fondation Ophtalmologique Rothschild in Paris, and colleagues wrote. “Although the pathogenesis of glaucoma after cataract surgery remains unclear, several risk factors have been identified.”
In a retrospective observational study, investigators analyzed 136 children (199 eyes) for risk factors of glaucoma and incidence of glaucoma after cataract removal with primary IOL implantation in their first year of life. Follow-up was performed under general anesthesia or until the child was able to sit for a full and reliable slit lamp examination. At each visit, IOP, corrected distance visual acuity, complications, additional surgical intervention and the need for glaucoma surgery were assessed.
Study results showed glaucoma development in 16% of eyes with a 5-year (12%) and 10-year (28%) incidence. Incidence was bimodal, with the first peak occurring at a mean of 2.5 months, and the second peak occurring at a mean of 5.7 years. Further multivariate analysis identified that longer follow-up (OR = 1.3; 95% CI, 1.11.6), reintervention (OR = 4.1; 95% CI, 1.213.4) and use of trypan blue (OR = 4.1; 95% CI, 1.3-13.1) were predictors for glaucoma development. Younger age at surgery, shorter axial length and bilateral surgery were also associated with a higher incidence of glaucoma.
“Our data suggest that the risk of SG cumulates over time with an estimated linear incidence rate of 3% per year,” Abdelmassih and colleagues concluded. “Follow-up should be started early and continued for an extended duration after surgery, and physicians should be particularly cautious in patients with one or several factors increasing the risk of SG.”
Perspective
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Cataract surgery in older adult patients is extremely safe, effective and highly successful. Unfortunately, it isn’t quite as straightforward for babies and children. Addressing pediatric cataracts tends to be more complicated with variable refractive outcomes and greater risk for postoperative complications, including the development of secondary glaucoma.
While the pathogenesis of glaucoma after cataract surgery remains unclear, previously suggested risk factors for developing secondary glaucoma in these patients include those with surgery performed at an early age, necessary additional procedures and requiring bilateral cataract surgery. In a retrospective analysis of pediatric cataract cases, Abdelmassih and colleagues agreed with these initial risk factors in addition to an axial length less than 16.5 mm and the use of trypan blue during surgery. Pediatric cataract patients have typically been left aphakic after surgery, but more commonly these days a posterior chamber IOL is being placed during the initial procedure. The bottom line? Regardless if a patient is aphakic or pseudophakic, they are still at risk for secondary glaucoma, and it is crucial to note that patients with congenital cataracts should be monitored closely for glaucoma so we can deter the potential effects of this sight-threatening disease.
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