Pediatric lensectomy and the glaucoma aftermath

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Glaucoma specialists nationwide reported that glaucoma-related adverse events were common after cataract surgery in children, and children who were younger than 3 months at the time of surgery had an elevated risk of adverse events in aphakic eyes.¹ Erick D. Bothun, MD, from the Department of Ophthalmology, Mayo Clinic, Rochester, MN, was the lead author of the study.

The researchers wanted to determine the cumulative incidence of glaucoma-related adverse events, ie, defined as glaucoma or glaucoma suspect, and factors associated with their risk during the first 5 years after lensectomy before children reach the age of 13 years.

The investigators used longitudinal registry data collected in this cohort study; the data were collected at enrollment and then annually for 5 years. Forty-five institutions and 16 community sites participated.

All children were 12 years old or younger and had completed at least 1 office visit after lensectomy from June 2012 to July 2015.

The main outcomes were the cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of the adverse events.

A total of 810 children (1,049 eyes) were included; 443 eyes of 321 children (mean age, 0.89 year) were aphakic after lensectomy, and 606 eyes of 489 children (mean age, 5.65 years) were pseudophakic.

The authors reported that the 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% confidence interval [CI], 25%-34%) in the 443 aphakic eyes and 7% (95% CI, 5%-9%) in the 606 pseudophakic eyes.

Of the aphakic and pseudophakic eyes, 7% and 3%, respectively, were diagnosed as glaucoma suspects.

The authors elaborated on their findings. In the aphakic eyes, a higher risk for glaucoma-related adverse events was associated with 4 of 8 factors, ie, age younger than 3 months, abnormal anterior segment, intraoperative complications at time of lensectomy, and bilaterality. The 2 factors that were evaluated for the pseudophakic eyes, that is, the laterality and anterior vitrectomy, were not associated with a risk of glaucoma-related adverse events.

The study concluded that the children who were pseudophakic and who were older at the time of surgery, developed a glaucoma-related adverse event less frequently within 5 years of the lensectomy. “The findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age,” they stated.

Reference:

1. Bothun ED, Repka MX, Kraker RT, et al. Incidence of glaucoma-related adverse events in the first 5 years after pediatric lensectomy. JAMA Ophthalmol. 2023;141:324-331; doi:10.1001/jamaophthalmol.2022.6413