Frequency and predictors of glaucoma after pediatric cataract surgery☆

Abstract 

Purpose

To determine the frequency of and identify predictors of chronic glaucoma after pediatric cataract surgery.

Design

Interventional case series.

Methods

Retrospective review at an eye hospital identified 570 eyes among 322 patients who underwent limbal-approach surgery without intraocular lens implantation at age ≤16 years for cataract unassociated with other ocular anomalies aside from microcornea. Patients had a minimum of 5 years' postoperative follow-up, which included intraocular pressure measurement. The outcome measure was the presence or absence of postcataract surgery glaucoma, defined as intraocular pressure ≥26 mm Hg, as measured on at least two occasions.

Results

Mean follow-up was 9.0 ± 3.1 years (median, 8.1 years; range, 5.0–18.3 years). Glaucoma developed in 118 of 570 patients' eyes (21%), including 101 of 272 (37%) undergoing surgery at ≤9 months of age and 17 of 298 (6%) undergoing surgery thereafter. Multivariable Cox proportional hazards regression analysis with adjustment for potential intrasubject correlation identified surgery at ≤9 months of age (hazard ratio [HR], 3.8; 95% confidence interval [CI], 1.8–7.7; P < .001), secondary membrane surgery (HR, 2.6; 95% CI, 1.3–5.3; P = .006), microcornea (HR, 1.9; 95% CI, 1.2–3.1; P = .008), and primary posterior capsulotomy/anterior vitrectomy (HR, 10.7; 95% CI, 1.4–80.6; P = .02) as predictors of glaucoma.

Conclusions

Chronic glaucoma is common after cataract surgery performed at or before, but not after, a certain age in childhood. The data suggest that this age threshold is 9 months, but a true threshold occurring at a somewhat later age cannot be fully excluded.