Abstract
Abstract: :
Purpose:Postoperative open angle glaucoma is emerging as potentially the most important visually disabling consequence of surgery for congenital cataract. We present an investigation of factors associated with glaucoma. Methods:248 children comprising a national cohort newly diagnosed with congenital and infantile cataract in 1995/6 in the UK were reviewed 6 years after diagnosis. Results:Preliminary findings are presented based on 275 eyes of 165 children in the cohort who underwent cataract extraction. 27 eyes developed postoperative open angle glaucoma. Using a Cox regression model we investigated a priori, the development of glaucoma associated with age at detection, age at cataract surgery, cataract surgery procedure, vitrectomy at primary procedure, primary intraocular lens implantation, significant postoperative uveitis, microphthalmia, cataract density, gender and laterality. Of these, microphthalmia and primary intraocular lens implantation, together with age at surgery and age at detection (which were highly correlated) were implicated by univariate analysis. However in the multivariate model, age at detection remained the only independently associated factor. A 10–fold increase in the age at detection (for example, 10 days compared to 1 day or 60 days compared to 6 days) was associated with a 64% decrease in the hazard ratio (95% CI=41%–79%, p<0.001). After taking into account the age of detection, there was a non–significant tendency for children who were older at surgery to have a lower risk of developing glaucoma. For example a child 1 week of age waiting until they were 1 month old to have surgery, would have on average a hazard ratio 37% lower than that for a child having immediate surgery. Conclusions:Early age at detection emerges as the most important factor associated with the development of glaucoma after congenital cataract surgery in this cohort. This paradoxically may be the price of successful screening programmes to ensure early detection and treatment of congenital cataract to mitigate against amblyopia. Further work is required to delineate precisely the optimal timing of surgery to balance the benefits of early intervention with potential risks.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • cataract • intraocular pressure