Clinical characteristics and treatment of secondary glaucoma, glaucoma suspects and ocular hypertension after congenital cataract surgery

Abstract

Objective: To evaluate changes in intraocular pressure after congenital cataract surgery in a real-world setting. Methods: This retrospective case series included all children aged 0–2 years undergoing lens extraction due to congenital cataract. Development of an elevated intraocular pressure was divided into three groups: secG, suspG and OHT. Further, risk factors for IOP changes, the therapeutic approach and functional outcome were assessed during follow-up. Results: One hundred and sixty-one eyes of 110 patients aged 0–2 years were included, whereof 29 eyes of 17 children developed secondary glaucoma (secG; 11 eyes/8 patients), glaucoma suspect (suspG; three eyes/three patients) or ocular hypertension (OHT; 15 eyes/10 patients). No difference in surgrical procedure ( p = 0.62) was found, but age at cataract surgery differed significantly ( p = 0.048), with the secG group (1.74 ± 1.01 months) being the youngest (suspG: 3.93 ± 1.80 months; OHT group: 5.91 ± 5.36 months). Secondary surgical intervention was significantly higher in the secG (4.64 ± 3.41) followed by the suspG (2.00 ± 2.65) and OHT groups (0.40 ± 0.74; p < 0.001). Postoperative complications including nystagmus ( p = 0.81), strabismus ( p = 0.98) and amblyopia ( p = 0.73) showed no difference, in contrast to visual axis obscuration which was more common in the secG group ( p = 0.036). Conclusion: Initial lensectomy and anterior vitrectomy procedure together with or without IOL implantation seems to have no influence for the development of IOP changes after pediatric cataract surgery. However, children who developed secondary glaucoma had cataract surgery significantly earlier, within the first 2–3 months of life. Glaucoma surgery was required to achieve final IOP control in most eyes. The development of secondary glaucoma was also associated with a significant increase in surgical re-treatments.

Predictors of Glaucoma After Pediatric Cataract Surgery

“…6,7 Reported frequency and risk factors for having GFCS vary according to study population, definition, and follow-up time, in a multitude of prospective and retrospective studies that have already been published on this topic. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Nonetheless, as reported in the Ninth Consensus Meeting of Childhood Glaucoma of the World Glaucoma Association, young age at the time of cataract surgery and microcornea consensually increase the risk of GFCS. 24 Typically, age <12 weeks at surgery is considered the critical timing.…”

“…17,27 The need for reinterventions after cataract surgery has also independently predicted the development of GFCS in some studies. 14 Other factors that failed to independently predict the development of GFCS include the laterality of the cataract, 14,18,19 the race and sex of the patient, 18,19 the presence of persistent fetal vasculature (PFV), 8,13,17 the surgical technique, more specifically, performing anterior vitrectomy, 14,19 intraoperative complications (hyphema, iris trauma, or prolapse) 11,14,19 and intraocular lens (IOL) implantation during surgery. 11,[13][14][15]17,19,22,26 The aim of this study was to report the rate, review potential independent risk factors, and report patient management of GFCS after both congenital and pediatric cataract surgery in a cohort of children who underwent cataract surgery in one of Portugal's 4 centers for both congenital and pediatric cataract over a period of 13 years (2008-2020).…”

“…In previous relevant studies on this subject, age at surgery has consistently been considered a relevant and significant predictor of the development of GFCS. 6,9,11,13,16,17,19,22,26 Classically, surgery before 12 weeks of age is considered the critical factor for increasing GFCS risk. Nonetheless, in our study, performing surgery before 16 weeks of age was also significantly associated with an increased risk of developing GFCS, in both univariable and multivariable analyses, while performing surgery before 28 weeks of age was not associated with the development of GFCS in multivariable analysis.…”

A Comprehensive Review of Pediatric Glaucoma Following Cataract Surgery and Progress in Treatment

“…Most published studies have found that early age at lensectomy is a risk factor for GFCS, especially in the first 3 months of life. 5,6,8,11,12,25,27,[31][32][33][34][35][36][37] The mechanism of early age at lensectomy has not been elucidated to date. Some hypotheses based on the experience of previous studies have been developed.…”

Incidence and risk factors of glaucoma after surgery for congenital cataract diagnosed under one year of age: Protocol for Korean Nationwide Epidemiological Study for Childhood Glaucoma (KoNEC)

“…As the long-term outcomes are often revealed to be poor, efforts have been made to identify risk factors. Although discordances among those studies exist, they have indicated possible associations of post-CC-surgery glaucoma development with age at detection of cataract and at cataract surgery, primary intraocular lens implantation, microphthalmia, and usage of trypan blue [ 2 , 3 , 5 , 7 , 15 – 18 ].…”