Young age, Black race among risk factors for glaucoma following pediatric cataract surgery
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Key takeaways:
- Glaucoma drainage device insertion was the most common glaucoma surgery after cataract surgery.
- GFCS risk was highest among infants and uncommon in older toddlers and children.
Age younger than 1 year at the time of cataract surgery, aphakia, Black race and unilateral cataract appeared linked to higher risk for developing pediatric glaucoma, according to a study published in Ophthalmology Glaucoma.
“Because childhood glaucoma is a rare group of diseases, of which GFCS is the most common iatrogenic cause, we investigated the IRIS Registry, the largest ophthalmic registry, to compare nationwide demographic, clinical and surgical patterns that were associated with GFCS between infants, toddlers and older children,” Daniel M. Vu, MD, associate fellowship director at Massachusetts Eye and Ear and assistant professor of ophthalmology at Harvard Medical School, and colleagues wrote.
To do this, the researchers conducted a retrospective cohort study including 6,658 children (median age, 10 years; 46.2% girls) from the IRIS Registry who underwent cataract surgery between January 2013 and December 2020.
The main outcomes of the study included cumulative probability of glaucoma diagnosis and surgical intervention within 5 years after cataract surgery, determined using the Kaplan-Meier estimator.
Researchers also evaluated several risk factors associated with glaucoma following cataract surgery (GFCS) and glaucoma surgery using multivariable Cox regression models: patient age at cataract surgery, sex, race and ethnicity, geographic location, type of insurance, cataract laterality, presence of persistent fetal vasculature (PFV) and microcornea, and IOL placement during cataract surgery.
Median follow-up was 1.7 years (interquartile range, 0.4-3.7 years).
The most common glaucoma surgery after cataract surgery was glaucoma drainage device insertion (32.6%), followed by angle surgery (23.3%), cyclophotocoagulation (15.1%) and trabeculectomy (5.8%), according to the researchers.
The 5-year cumulative probability for GFCS overall was 7.1% and for glaucoma surgery was 2.6%.
For children aged younger than 1 year at the time of surgery, the 5-year cumulative probability for GFCS was 22.3%.
Higher risk for GFCS was associated with aphakia (HR = 2.63), Black race (HR = 1.61) and unilateral cataract (HR = 1.48), whereas presence of PFV lowered the risk (HR = 0.35).
Additionally, higher risk for glaucoma surgery after cataract removal was associated with age younger than 1 year at cataract removal (HR = 2.55), indicating that GFCS is “more aggressive” in younger children, according to the researchers. Other risk factors for glaucoma surgery included aphakia (HR = 2.56) and unilateral cataract (HR = 1.72).
“This study shows that GFCS is quite uncommon in older children and older toddlers,” the researcher wrote. “Potential risk factors such as race require further study, especially in the context of social determinants of health. Glaucoma drainage device insertion was most often the initial choice for GFCS surgical treatment, but future comparative studies between different surgeries for GFCS and their outcomes may be warranted.”
Perspective
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While we naturally focus on types of glaucoma that are commonly seen in practice, we must not forget the less common variations. Pediatric GFCS is a rare but serious condition. Trauma, uveitis and steroid response are leading mechanisms for glaucoma development in these situations. Both unilateral and bilateral (more likely associated with systemic conditions) cataract surgery have been linked to glaucoma development.
In this study, patients younger than 1 year were particularly likely to develop GFCS. The overall probability of GFCS development in 5 years was less than 10% but was more than 20% for those who had the procedure before age 1. Black patients also were at higher risk, while GFCS was uncommon in older children or toddlers.
This study suggests the importance of further research into a less understood condition and a tailored approach to treatment in higher-risk individuals. Alternatives to glaucoma drainage device insertion (the most commonly used treatment) should be explored for greater effectiveness, particularly in the highest-risk groups.
Health care providers cannot apply a one-size-fits-all approach and must understand different considerations for each individual. Further research should focus on the causes of increased risk for Black and younger patients.
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