Abstract
Purpose :
Glaucoma is a common complication following cataract surgery in patients with persistent fetal vasculature (PFV). We aim to identify risk factors predisposing to glaucoma in this population and characterize the optic nerve appearance and treatment outcomes.
Methods :
This is a retrospective cohort study of patients with PFV-related cataracts at a single tertiary care center. We included all infants who underwent cataract surgery without primary intraocular lens placement before one year of age, with at least five years of follow-up. The primary outcome was a diagnosis of glaucoma or ocular hypertension requiring treatment. Risk factors investigated included age, sex, and the presence of microcornea (horizontal diameter less than 10 mm). Secondary outcomes included type of treatment, optic nerve appearance, and visual acuity. We performed univariate and multivariable regressions and report odds ratios (OR) and 95% confidence intervals (CIs).
Results :
36 eyes from 34 patients were included. The median age at the time of cataract surgery was 1.3 months (Interquartile range [IQR] 1.0-2.2 months). 38% of patients were female and 50% were left eyes. Following surgery, 39% of eyes developed glaucoma or ocular hypertension. The median age of glaucoma diagnosis was 2.5 years (IQR 0.4-6.2 years). The median cup to disc ratio was 0.25 and 50% had visual acuity of 20/200 or worse. All of these patients were treated with topical medication such as timolol, latanoprost, and timolol-dorzolamide. Six of the eyes underwent glaucoma surgery at a median age of 7.5 months (IQR 3.7-45.2 months), most commonly goniotomy and trabeculotomy. Patients who developed glaucoma were more likely to have microcornea (77% vs. 36%, p = 0.040) (Table 1). While univariate regression identified microcornea as a significant risk factor for glaucoma in eyes with PFV (OR 4.37, 95% CI 1.08-20.6, p = 0.046), after adjusting for age at surgery, microcornea was no longer significant (OR 3.09, 95% CI 0.68-16.0, p = 0.2) (Table 2).
Conclusions :
Microcornea is frequently observed in the patients with PFV who develop glaucoma or ocular hypertension. A greater understanding of potential risk factors and treatment outcomes can help guide interventions.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.