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  • Glaucoma Development May Occur Many Years After Infantile Cataract Surgery

    Cataract/Anterior Segment, Glaucoma, Pediatric Ophth/Strabismus

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    Review of: Timing of diagnosis and treatment of glaucoma following infantile cataract surgery

    Nihalani B, VanderVeen D. Ophthalmology Glaucoma, May/June 2024

    Infants who undergo cataract surgery soon after birth are at risk of developing glaucoma following cataract surgery (GFCS), even many years after the procedure.

    Study Design

    This was a cross-sectional, chart review study of all infants (N = 260) who underwent unilateral or bilateral cataract surgery at a single institution over a 30-year span. Infants were excluded if there was <1 year of follow-up, if they had pre-existing glaucoma, or if the cataracts were secondary to trauma or retinal detachments.

    Outcomes

    A total of 260 patients (383 eyes) met inclusion criteria; median age at the time of cataract surgery was 52 days. Twenty-seven percent of eyes developed GFCS during the follow-up period (median 13.4 years). Thirty-four percent of the eyes operated on within the first 3 months of life developed GFCS, compared with only 15% of those operated on after the first 3 months of life; a linear regression analysis confirmed younger age as a major risk factor for GFCS. Other significant risk factors for GFCS development included microcornea, poorly dilating pupils, and anterior-segment dysgenesis. Additionally, early-onset GFCS (<1 year after cataract surgery) was more likely to require surgical management than late-onset GFCS (>1 year after cataract surgery).

    Limitations

    The limitations inherent to all retrospective studies also apply to this study. Additionally, all of these surgeries were performed at a tertiary care academic center; therefore, it is possible that this group of patients differs in demographics or severity of diagnosis when compared with patients seen at other types of practices, potentially limiting the findings’ applicability.

    Clinical Significance

    Results of this study show that GFCS can develop even years after the initial surgery, affirming that patients undergoing cataract surgery as infants require long-term and even lifelong follow-up. Particular attention may be paid to those with anterior-segment abnormalities. When GFCS does occur, surgical intervention is likely to be required in early-onset GFCS, while medical management is more likely to suffice in later-onset GFCS.

    Financial Disclosures: Dr. Robert Tauscher discloses no financial relationships.