More evidence of increased glaucoma risk after cataract surgery in younger infants

This retrospective study of cataract surgery in infants younger than 12 months found an increased risk of glaucoma when surgery was performed during the first month of life and in those with bilateral cataract.

The study included 101 patients less than 12 months old who underwent lens extraction for unilateral or bilateral cataracts at one of two tertiary referral centers in Australia between January 1992 and May 2006. Median follow-up was 9.9 years.

The cumulative incidence of glaucoma was 30.7 percent. Incidence of glaucoma was higher in children with bilateral cataract (38.9 vs. 17.1 percent, P = 0.004), and the incidence rate was the highest for infants who underwent surgery during the first month of life. The risk of glaucoma decreased with increasing months of age at operation (P= 0.001). Median visual acuity was worse in children with unilateral cataract (p< 0.001).

There was an approximately 20 percent reduced risk of glaucoma with each month that surgery was deferred, although the authors note that this needs to be carefully balanced with the increasing risk of amblyopia from deferred surgery.

Since glaucoma may develop even a decade after lens extraction, the authors say that all patients must undergo lifelong surveillance to prevent glaucoma-associated vision loss. They endorse the recommendation of a previously published study that infantile and congenital cataract patients be examined every three months during the first postoperative year, twice yearly for the next decade and annually after that. They also recommend prospective studies to determine the optimal timing of surgery.