Glaucoma Following Cataract Surgery
Aphakic glaucoma is a common form of secondary glaucoma in childhood. The reported incidence of open-angle aphakic glaucoma after congenital cataract surgery varies from 15% to 50% or higher. Aphakic glaucoma often develops years after cataract surgery, but it can occur within weeks to months of surgery and remains a lifelong risk. Consequently, patients who have undergone cataract surgery in childhood require regular ophthalmic examination. The children at highest risk for glaucoma development following cataract surgery are those who have surgery during infancy, and the risk appears to be even higher in patients with microcornea or persistent fetal vasculature.
The mechanism of aphakic glaucoma is unclear. The anterior chamber angle usually appears open on gonioscopy; the outflow channels are compromised by some combination of abnormal development of the anterior chamber angle and perhaps susceptibility of the infant eye to surgically induced inflammation, loss of lens support, retained lens epithelial cells, or vitreous factors.
Acute or subacute angle closure with iris bombé is a rare form of aphakic glaucoma. Although it usually occurs soon after surgery, onset can be delayed by a year or more. The diagnosis should be apparent with a slit lamp, but examination at the slit lamp may be difficult in young children. Treatment consists of anterior vitrectomy to relieve the pupillary block, often with surgical iridectomy and goniosynechialysis.
Freedman SF, Lynn MJ, Beck AD, Bothun ED, Örge FH, Lambert SR; Infant Aphakia Treatment Study Group. Glaucoma-related adverse events in the first 5 years after unilateral cataract removal in the Infant Aphakia Treatment Study. JAMA Ophthalmol. 2015;133(8):907–914.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.