Structural risk factors for glaucoma following congenital cataract surgery

Abstract

Purpose : Glaucoma following congenital cataract surgery (GFCCS) is a severe well-recognized complication following pediatric lensectomy, yet its etiology is not well understood. Corneal diameter and central corneal thickness are established pre- and post-lensectomy risk factors for GFCCS, respectively; there are few studies exploring a comprehensive set of structural risk factors in this population. This longitudinal cohort study aims to use ultrasound biomicroscopy (UBM) to analyze pre- and post-operative anterior segment differences between eyes that developed GFCCS and eyes that did not in children under 5 years of age to identify structural variables associated with GFCCS.

Methods : UBM images were collected in children under 5 years of age before and after cataract surgery and 27 anterior chamber parameters in 198 images were measured using ImageJ. Preoperative images of aphakic and pseudophakic eyes that later developed glaucoma (4 eyes in 2 patients) were compared against preoperative images of eyes that did not develop glaucoma (7 eyes in 4 patients) to identify pre-lensectomy parameters that may correlate with development of GFCCS. Postoperative images between these groups (7 eyes in 4 patients in GFCCS group, 2 eyes in 2 patients in non-GFCCS group) were also analyzed. Statistical analysis was conducted using the Mann-Whitney U test and relative risks (RR) were calculated for each parameter.

Results : Significant pre- and post-operative structural differences in GFCCS eyes versus eyes without GFCCS are summarized in Table 1 and 2 respectively. Preoperatively, eyes that later developed glaucoma demonstrated a shallower anterior chamber, narrower angle, and thinner iris compared to eyes that did not develop glaucoma. Postoperatively, eyes with glaucoma were found to have a thicker central cornea, shallower anterior chamber, and narrower angle compared to eyes without glaucoma.

Conclusions : Several structural risk factors were identified that may help both diagnose and predict GFCCS. Future directions include a more specific risk prediction profile based on preoperative structural anatomy and exploration of our ability to modify these structural risk factors to treat or prevent GFCCS.

This is a 2020 ARVO Annual Meeting abstract.

 

Table 1: Preoperative findings in GFCCS eyes versus non-GFCCS eyes with P-values and RR for GCFFS.

 

Table 2: Postoperative findings in GFCCS eyes versus non-GFCCS eyes with P-values and RR for GCFFS.