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Age at the time of cataract surgery and relative risk for aphakic glaucoma in nontraumatic infantile cataract without microcornea

Arif O. Khan MD, Saad Al-Dahmash MD      (Published in JAAPOS April 2009)


To report the relative risk for aphakic glaucoma as function of age at surgery in infants
who underwent cataract surgery before 10 months of age for nontraumatic infantile
cataract without microcornea.

Institutional retrospective case series (January 1985-February 2003) of children who
underwent cataract surgery without intraocular lens implantation for nontraumatic
infantile cataract before 10 months of age. Patients with less than 5 years’ postsurgical
follow-up, microcornea, persistent fetal vasculature, and/or other significant anterior
segment abnormality were excluded.
The surgical procedure in all cases was lens aspiration, posterior capsulotomy, and
anterior vitrectomy with anterior small-incision techniques. Of 210 eyes (121 patients),
55 eyes (26.2%) (31 patients [25.6%]) developed aphakic glaucoma. Relative risk for
later aphakic glaucoma as a function of age at the time of surgery declined from 1.85
(95% CI, 0.88-3.86) at 0-1 months of age to a nadir at 3-4 months of age (0.22 [95% CI,
0.05-0.96]) and then rose again to peak at 3.17 [95% CI, 1.1-9.11] at 5-6 months of age.

Overlapping and at times wide 95% confidence intervals limit firm conclusions regarding
an age of surgery at highest risk. The lowest relative risk for later aphakic glaucoma in
our cohort was for surgery performed at 3-4 months of age, for which the 95%
confidence interval remained below 1.0. However, because of amblyopia issues we do
not recommend delaying congenital cataract surgery beyond 4 weeks of life.


Glaucoma after paediatric cataract surgery.

Saad Al-Dahmash,MD,Sami al-Shahwan,MD,Arif Khan,MD. (Published in SJO March 2009)




To compare glaucoma after pediatric cataract surgery in children who did and children who did not undergo primary posterior chamber lens (PCIOL) implantation.


Retrospective case series.

Patients and Methods

An institutional retrospective chart review was performed of all patients who underwent pediatric cataract surgery with and without primary PCIOL implantation before the age of 12 years (from January 1985 to February 2003); the review excluded microcornea and any condition independently associated with glaucoma. Patients had a minimum of 5 years (60 months) postoperative follow up, which had to include intraocular pressure measurements. The outcome measure was the presence or absence of post paediatric cataract surgery glaucoma, defined as persistently elevated intraocular pressure ≥ 28 mmHg, as measured on at least 2 occasions with confirmation of the diagnosis by the treating ophthalmologist.


A total of 489 pseudophakic eyes and 269 aphakic eyes met our inclusion criteria. Eight eyes (1.6%) out of the 489 pseudophakic eyes were diagnosed with glaucoma, whereas 62 eyes (23%) out of the 269 aphakic eyes were diagnosed with glaucoma. Mean age at time of surgery for the pseudophakic eyes was 45.6 months (standard deviation [SD] +32.3) and for the aphakic eyes was  10.1 months  (SD +18.9). Mean follow up period postoperatively was 70.4 months (SD ±12.5) and 123.7 months (SD ±66.2 in the pseudophakic and aphakic eyes respectively. The presence of postoperative complication(s) as well as the need for further intraocular surgery were risk factors for glaucoma development in the aphakic eyes. Glaucoma was diagnosed at an earlier onset in the pseudophakic eyes compared with the aphakic eyes (15.8 months ± 18.8 vs 59.0 months ± 44.0, P <0.0001). Glaucoma control was more difficult in the aphakic eyes than in the pseudophakic eyes.


Pseudophakic eyes had a significantly lower glaucoma incidence than aphakic eyes; however, because surgery was performed later in pseudophakic eyes we cannot conclude a protective effect from primary PCIOL implantation.  Early age at cataract surgery as well as the presence of postoperative complication(s) and the need for further intraocular surgery(s) are risk factors for glaucoma development. Glaucoma after cataract surgery before 10 months of life tends to occur later and to be more difficult to control.

Key words: Glaucoma, pediatric cataract surgery, aphakia and pseudophakic.



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