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L.S. Bhatia, D.S. Walton, T.C. Chen; Aphakic Glaucoma after Congenital Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2003;44(13):94.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report the findings of the largest series of patients who developed glaucoma after lensectomy for congenital cataracts. Methods: A retrospective review was done of charts from DSW's office from October 1970 to November 2002. Patients with intraocular pressures above 25 mm Hg after lensectomy for congenital cataracts were studied. Patients were excluded if they had a history of trauma, neoplasm, radiation therapy, anterior uveitis, Lowe's syndrome, maternal rubella syndrome, Stickler's syndrome, Trisomy 13, iridocorneal dysgenesis, or any syndrome independently associated with glaucoma. Patients with signs of glaucoma prior to lensectomy were also excluded. Patients with a history of steroid use prior to lensectomy or with a history of maternal steroid use were also excluded. Results: 172 eyes of 118 patients with aphakic glaucoma were studied. There were 56 boys and 62 girls. 54 patients had bilateral lensectomies and 64 patients had unilateral lensectomy. 39 eyes were operated on by DSW and 133 eyes by other surgeons. 54 patients had bilateral aphakic glaucoma. 30 patients had bilateral lensectomy but developed aphakic glaucoma in one eye. 34 patients had unilateral lensectomy and developed aphakic glaucoma.105 eyes underwent lensectomy using modern vitrectomy instruments whereas 10 patients had lensectomy using older techniques (eg. needling, aspiration, or linear extraction). The operative techniques of 57 eyes were unknown. 92 (53.5%) eyes had lensectomy before 2 months of age and 140 (81.4%) eyes before 1 year of age. Average follow-up time was 8.6 years ± 7.6 (range: 1 month to 28 years). Open angle glaucoma was the most common type of glaucoma with gonioscopy showing open angles in 141 (94%) out of 150 eyes examined. 64 (37.2%) eyes developed aphakic glaucoma by 1 year after lensectomy. 129 (75%) eyes developed aphakic glaucoma by 6 years after lensectomy. The latest time after lensectomy that glaucoma developed was at 33 years. 71 eyes were operated on for postoperative complications: 54.9% for pupillary membranes, 12.7% for residual lens material, and 7% for after cataract. 99 eyes needed glaucoma surgery (ie. 24 goniotomies/ trabeculotomies, 63 trabeculectomies, 32 tubes, 21 cycloablations, etc.) to control their glaucoma. Conclusions: Most cases of aphakic glaucoma are of the open angle type and result from lensectomy done during the first year of life. Although 75% of eyes had developed aphakic glaucoma by 6 years after lensectomy, lifelong follow-up of these lensectomy patients is still needed to screen for glaucoma. CR: None Support: None
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