The aetiology in paediatric aphakic glaucoma

Abstract

Purpose To investigate the causes of glaucoma in children following removal of cataracts. Methods In total, 24 patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma following cataract removal were studied retrospectively. Cataract morphology, surgical technique, postoperative complications, time to glaucoma onset, gonioscopic findings, the presence of microcornea, and the histopathologic characteristics of the filtration angle in one case were the studied parameters. Results We found a bimodal onset of glaucoma. Early-onset glaucoma occurred at a mean age of 6 months in 15 eyes and delayedonset glaucoma at a mean age of 12 years in 22 eyes. Early-onset glaucoma was significantly (P ¼ 0.018) more likely to be due to angle closure. With delayed-onset glaucoma, the filtration angle is open in 86% of eyes and significantly (P ¼ 0.006) more eyes in the delayed-onset group had microcornea. Conclusions Performing cataract surgery very early in life in microphthalmic eyes and leaving residual lens material increases the risk for glaucoma. We recommend a prophylactic iridectomy in eyes at risk for pupillary block. Eyes with delayed-onset glaucoma have open filtration angles but with findings consistent with incomplete development of filtration structures. Early age at cataract extraction and microcornea are risk factors for delayed-onset glaucoma.

Central corneal thickness and intraocular pressure in children undergoing congenital cataract surgery: a prospective, longitudinal study

“…First, our mean follow-up was short compared with other studies, where the mean follow-up was higher than 5 years 4 10 33. Also, the improvement in surgical techniques (smaller incisions, decreased surgical time, posterior capsulotomy with anterior vitrectomy, use of foldable IOL at earlier ages)8 31 34 may have reduced the incidence of postoperative complications, including glaucoma.…”

Incidence of early-onset glaucoma after infant cataract extraction with and without intraocular lens implantation

“…Surgery during the first year of life is thought to increase the risk of glaucoma,3 5 16 and so this cohort is a high risk eyes for development of glaucoma. Previous studies indicate a bimodal aphakic glaucoma onset:4 11 15 with early glaucoma presenting within the first year after lensectomy significantly associated with angle closure, and a late open-angle glaucoma occurring much later,11 15 but not all these studies were restricted to infants.…”

Bag-in-the-lens intraocular lens implantation in the pediatric eye

“…In one study, 29 the incidence of glaucoma was 24.4% in pseudophakic eyes and 19.0% in aphakic eyes. Koc et al 30 report bimodal onset of glaucoma, with early-onset glaucoma occurring at a mean age of 6 months (likely resulting from angle closure) and delayed-onset glaucoma at a mean age of 12 years (in 86%, resulting from an open filtration angle). Chen et al 28 found an open angle in 93.9% of cases of aphakic glaucoma.…”