Intraocular lens implantation as an isolated risk factor for secondary glaucoma in pediatric patients

Yagev, Ronit; Khatib, Nur; Barrett, C.B.; Lior, Yotam; Lifshitz, Tova; Tsumi, Erez

doi:10.1016/j.jcjo.2019.01.003

“…A total of 16 of the 20 references eventually included [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] provided data on the number of cases in the included studies, while 18 provided data on the proportion of female participants in the included studies. In the literature, 948 eyes with glaucoma treated with IOLs were included.…”

Section: Included Literature Basic Informationmentioning

confidence: 99%

Meta-Analysis of the Comprehensive Efficacy of Intraocular Lens Implantation in Glaucoma Patients

Zhou

¹

2022

BioMed Research International

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This study is aimed at investigating the efficacy of intraocular lens (IOL) implantation in patients suffering from glaucoma through meta-analysis of the previously published research. For this purpose, different literature databases were searched for identification of clinical studies published between January 2000 and January 2022 on evaluating IOL’s efficacy in treating glaucoma. RevMan 5.3 was used to conduct a meta-analysis of the pertinent data. The central anterior chamber depth (ACD), corneal endothelial cell counts, best-corrected visual acuity (BCVA), intraocular pressure (IOP), anti-glaucoma medications (AGM), and axial length (AL) changes were compared, and the incidence of postoperative complications was thoroughly evaluated. The Cochran chi-square test was used to examine the heterogeneity of the evaluation results. According to the inclusion and exclusion criteria, 20 studies included 948 glaucomatous eyes. IOP was significantly lower than before treatment ( MD = 8.64 , 95 CI: 5.75-11.53; Z = 5.86 , P < 0.0001 ), while ACD increased significantly ( MD = − 1.38 , 95 percent CI: -1.74-1.02; Z = 7.49 , P < 0.0001 ). The corneal endothelial cell counts were homogeneous ( MD = 225.08 , 95% CI: -64.17 to -514.33; Z = 1.53 , P = 0.20 ). AGM utilisation decreased ( MD = 1.43 , 95% CI: 0.752.12, Z = 4.09 , P < 0.0001 ). AL decreased significantly ( MD = 0.31 ; 95% CI: 0.09-0.54; Z = 2.71 ; P = 0.007 ). The incidence of complications remained insignificant after IOL treatment ( OR = 1.05 , 95% CI: 0.42 to 2.60; Z = 0.10 , P = 0.92 ; P = 0.92 ). These findings indicate that IOL treatment can significantly reduce intraocular pressure, glaucoma drug use, and aqueous level (AL) in glaucoma patients while increasing the depth of the central anterior chamber. This study offers a theoretical foundation for selecting glaucoma treatment methods.

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“…On the other hand, more recent reports utilizing modern surgical techniques revealed a reduced incidence of glaucoma in pseudophakic eyes, indicating that primary IOL implantation combined with anterior vitrectomy does not elevate the risk of secondary glaucoma [16][17][18][19]. In addition, other large-scale analyses underscored that primary IOL implantation serves as a protective factor against glaucoma development after congenital cataract surgery [20][21][22][23]. To rationalize how primary IOL implantation in pediatric patients with cataracts might reduce glaucoma incidence, two hypotheses have been proposed [20,23].…”

Section: Discussionmentioning

confidence: 99%

10-Year Outcomes of Pediatric Cataract Surgery with Foldable Intraocular Lens Implantation and Posterior Continuous Curvilinear Capsulorhexis

Oshika,

Kiuchi

2023

Ophthalmol Ther

2

0

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Introduction We investigated the long-term outcomes of pediatric cataract surgeries performed with modern surgical techniques involving in-the-bag implantation of a foldable intraocular lens (IOL). Methods Data were retrospectively collected from 42 eyes in 30 patients who underwent surgery at 6 years and younger (average 2.5 ± 2.3 years) and were followed up for an average of 12.2 ± 2.4 years (10–17 years). Surgical procedures included anterior continuous curvilinear capsulorhexis (CCC), lens removal, posterior CCC, anterior vitrectomy, and in-the-bag IOL implantation. There were 18 unilateral (2.7 ± 2.3 years) and 12 bilateral cases (2.3 ± 2.3 years), with no significant age difference between groups ( p = 0.462). Results The mean best-corrected visual acuity (BCVA) at the final visit was 0.453 ± 0.488 (logMAR), correlating significantly with the age at surgery ( r = −0.307, p = 0.048). The unilateral group had a worse BCVA (0.658 ± 0.615) than the bilateral group (0.298 ± 0.294) ( p < 0.001). On average, eyes showed a myopic shift of −6.0 ± 6.3D, which significantly correlated with surgical age ( r = 0.402, p = 0.008). While the myopic shift was −8.2 ± 6.1 D in the unilateral group and −4.9 ± 6.4 D in the bilateral group, the net shift for unilateral cases (comparing pseudophakic and fellow eyes) was −4.8 D. Three eyes (7.1%) exhibited suspected glaucoma (increased intraocular pressure), but no glaucoma or other severe complications were noted. IOL exchange surgery was necessary in two eyes (4.8%) due to pronounced myopic drift and significant IOL decentration. Three eyes (7.1%) required surgery for significant visual axis opacification. Conclusions Contemporary surgical strategies appear to yield promising long-term outcomes in patients with infantile cataracts.

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“…The majority of the included literature exists as retrospective case series with small sample sizes. El Sayed et al includes the largest sample size of GFCS eyes (29) and was the single study conducted in a prospective manner [57]. Caution must be taken when extrapolating data based on small sample sizes, as the eyes included may not always be representative of the population in ways apparent during data collection.…”

Section: Discussionmentioning

confidence: 99%

“…Time between cataract surgery and glaucoma diagnosis has ranged in the literature from 2.5 months to over 5 years [11,23,24]. In addition, associations between risk of GFCS and various factors of the cataract surgery have been investigated, such as aphakia vs. pseudophakia after cataract extraction, and use of intra-operative anti-inflammatory agent [25][26][27][28][29][30]. These factors, however, have failed to demonstrate a reproducible and significant association with increased risk of GFCS.…”

Section: Introductionmentioning

confidence: 99%

Angle Surgery in Pediatric Glaucoma Following Cataract Surgery

Jamerson

¹

,

Solyman

²

,

Yacoub

³

et al. 2021

Vision

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Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of surgery, microcornea, and additional surgical interventions. The exact mechanism for GFCS has yet to be completely elucidated. While medical therapy is the first line for treatment of GFCS, many eyes require surgical intervention, with various surgical modalities each posing a unique host of risks and benefits. Angle surgical techniques include goniotomy and trabeculotomy, with trabeculotomy demonstrating increased success over goniotomy as an initial procedure in pediatric eyes with GFCS given the success demonstrated throughout the literature in reducing IOP and number of IOP-lowering medications required post-operatively. The advent of microcatheter facilitated circumferential trabeculotomies lead to increased success compared to traditional <180° rigid probe trabeculotomy in GFCS. The advent of two-site rigid-probe trabeculotomy indicated that similar results could be attained without the use of the more expensive microcatheter system. Further studies of larger scale, with increased follow-up, and utilizing randomization would be beneficial in determining optimum surgical management of pediatric GFCS.

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Intraocular lens implantation as an isolated risk factor for secondary glaucoma in pediatric patients

Cited by 12 publications

References 22 publications

Meta-Analysis of the Comprehensive Efficacy of Intraocular Lens Implantation in Glaucoma Patients

Meta-Analysis of the Comprehensive Efficacy of Intraocular Lens Implantation in Glaucoma Patients

10-Year Outcomes of Pediatric Cataract Surgery with Foldable Intraocular Lens Implantation and Posterior Continuous Curvilinear Capsulorhexis

Angle Surgery in Pediatric Glaucoma Following Cataract Surgery

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