ASCRS 2023: Risk factors for glaucoma after infantile cataract surgery

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The true incidence rate of the development of glaucoma after pediatric patients undergo cataract surgery is unknown, with the rates ranging from 8% to 59%.

In this recent study, Bharti Nihalani-Gangwani, MD, from the Department of Ophthalmology, Children’s Hospital, and Deborah VanderVeen, MD, from the Department of Ophthalmology, Harvard Medical School, Boston, reported that 29% developed glaucoma in a large infant cohort and the risk factors at the American Society of Cataract and Refractive Surgery annual meeting.

The investigators undertook a chart review of patients that spanned 30 years. The inclusion criterion included follow-up for at least 1 year. In this study, the definition of glaucoma was an intraocular pressure that exceeded 25 mmHg at 2 consecutive visits and changes in the optic nerve head.

Drs. Nihalani-Gangwani and VanderVeen evaluated the patient age at the time of cataract surgery; the presence of a micro-cornea, defined as a corneal diameter below 9 mm); the cataract morphology, the time to the development of glaucoma after cataract surgery, and the type of treatment.

Chart review results

A total of 212 patients (319 eyes) were included in the analysis. The patient median age at the time of cataract surgery was 50 days (range, 11-325 days), and the median follow-up was 8.8 years (range, 1-26.3 years), the researchers reported.

They found that the incidence of glaucoma after surgery in this pediatric cohort was 29%.

In 82% of the eyes in which glaucoma developed postoperatively, the patient age at the time of surgery was younger than 3 months (p=0.001). Other relevant factors in the development of glaucoma included the presence of a micro-cornea (44%, p<0.0001), poor pupillary dilation (10%, p=0.004), persistent fetal vasculature (12%, p=0.8), and anterior-segment dysgenesis (3%, p=0.02), the authors reported.

They also found that in the 76% of patients in whom the glaucoma developed within a year after the cataract surgery, surgical intervention was required in contrast to the 13% in whom glaucoma developed more than 1 year after the cataract surgery (p=0.0002). In that latter group, medical treatment was effective for controlling the later-onset glaucoma in 87%.

The take-aways from this study were the 29% incidence of glaucoma after cataract surgery and the major risk factors that included the younger age at surgery and the presence of a micro-cornea and poor pupillary dilation.

The related findings were that patients with early-onset glaucoma were more than likely going to need surgery, but glaucoma that developed later responded to medical therapy in a high percentage of patients.