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  • Glaucoma After Pediatric Lensectomy

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, January 2020

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    Understanding the incidence and risk factors related to glaucoma after cataract surgery in children can help to guide disease management. Freedman et al., for the Pediatric Eye Disease Investiga­tor Group, looked at the frequency of glaucoma in the year following pediatric lensectomy. In their study of children under 13 years of age, the incidence of confirmed or suspected glaucoma was 6.3%. Possible risk factors were aphakia and younger age.

    This multicenter study included 702 children (970 eyes) who received uni­lateral or bilateral lensectomy between June 2012 and July 2015 in the United States (57 sites), Canada (three sites), or the United Kingdom (one site). Glauco­ma and suspected glaucoma had been diagnosed using standardized criteria. Patients were required to have at least one follow-up visit between six and 18 months after lensectomy. The primary outcome was the risk of glaucoma.

    The mean age of the study group was 3.4 years; 50% were male; and 61% were white. Following cataract surgery, glaucoma was confirmed for 52 eyes and suspected in 14 (adjusted overall risk, 6.3%). The mean age at lensecto­my in glaucomatous eyes was 1.9 years (range, 0.07-11.2 years). Glaucoma surgery was performed in 23 (34.8%) of the 66 affected eyes, at a median of 3.3 months after lensectomy (range, 0.9-14.8 months).

    The risk of confirmed or suspected glaucoma was 15.7% for children aged three months or younger at lensecto­my, 3.4% for those older than three months, 11.2% among aphakic eyes, and 2.6% for pseudophakic eyes. Variables that did not appear related to glaucoma development were sex, race/ethnicity, laterality of lensectomy, use/nonuse of anterior vitrectomy, anterior segment abnormality before lensecto­my, and intraoperative complications.

    The authors concluded that only a small number of children are at risk for glaucoma in the year following cataract removal. Frequent monitoring for signs of glaucoma is warranted after pediatric lensectomy, said the authors, especially in young infants and children with post-op aphakia. Monitoring of the study group will continue through five years following lensectomy, which may uncover more cases and show a different risk factor profile. “Such long-term data may help the pediatric cataract surgeon better understand the risk factors and pathogenesis of glaucoma following lensectomy,” said the authors, which may lead to better treatment strategies.

    The original article can be found here.