Abstract
Purpose: :
To determine prevalence and risk factors for development of glaucoma after infantile cataract surgery
Methods: :
All infants with unilateral and bilateral cataracts operated on within first year of life at Children’s Hospital Boston between 1991 and 2007 were identified. All the infants underwent posterior capsulotomy and anterior vitrectomy. 9 eyes had primary intraocular lens implantation (IOL), remaining patients were fitted with contact lenses approximately 1 week after surgery. Glaucoma was considered when intraocular pressure (IOP) was measured to be greater than 20 mm Hg by applanation tonometry, or when development of buphthalmos, abnormal increase in axial length, or corneal or optic nerve changes occurred. The prevalence of glaucoma was recorded. The identified glaucoma cases were further evaluated to determine risk factors for development of glaucoma
Results: :
164 eyes of 110 infants (63 males, 47 females) were identified. 54 infants had bilateral and 56 had unilateral cataracts. Mean follow up after surgery was 63 months. Prevalence of glaucoma was 9.8% (16/164 eyes). Mean age at surgery was 12.6 weeks (Median 18 weeks). Mean age at surgery for development of glaucoma was 9.4 weeks (Median 6 weeks). Glaucoma was identified in 11 eyes with bilateral cataract and 4 eyes with unilateral cataract. For bilateral patients, 4 patients had glaucoma in both eyes and 3 had glaucoma in only one eye. Overall, 5 eyes had associated microcornea and microphthalmos, 3 eyes had persistent fetal vasculature (PFV), 2 eyes had angle anomalies noted on gonioscopy, 2 eyes had post-operative complications with resolution of glaucoma after appropriate treatment, 2 eyes of one patient had steroid response glaucoma, and 2 eyes of one patient had open angles with peripheral iridectomy and no identified cause. After excluding 4 patients with postoperative glaucoma which resolved, 4 of the remaining 12 patients required glaucoma procedures to control IOP. 3 of these 4 patients required more than one surgery to control glaucoma.
Conclusions: :
The prevalence of glaucoma in infants was 9.8% after infantile cataract surgery; however 4 eyes (25%) experienced resolution after appropriate treatment of post-surgical complications. 75% had chronic glaucoma. Cataract surgery in first 10 weeks of life, microcornea and microphthamos, PFV and angle abnormalities were identified as risk factors for development of glaucoma, and surgical complications were identified as a common cause of early post-operative glaucoma.
Keywords: clinical (human) or epidemiologic studies: risk factor assessment • clinical (human) or epidemiologic studies: prevalence/incidence • intraocular pressure