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  • Pediatric Lensectomy and Glaucoma-Related AEs

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, April 2023

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    After lensectomy, how do children with pediatric cataracts fare with regard to glaucoma-related adverse events (AEs)? In a report for the Pediatric Eye Disease Investigator Group (PEDIG), Bothun et al. set out to answer this question. They found that glaucoma-related AEs were common in aphakic eyes within five years of lensectomy—and that children with pseudophakia, who tended to be older at the time of surgery, were less likely to develop a glaucoma-related AE.

    For this prospective longitudinal study, the PEDIG researchers collected data on children who were 12 years old or younger at the time they underwent unilateral or bilateral lensectomy. This analysis comprised 810 children (1,049 eyes) who had at least one follow-up examination within 5.5 years following their initial surgery.

    Median age at first lens surgery was .21 years in aphakic eyes and 5.32 years in pseudophakic eyes. The five-year cumulative incidence of glaucoma-related AEs was 29% in 443 eyes with aphakia and 7% in 606 eyes with pseudophakia. In addition, 7% of aphakic eyes and 3% of pseudophakic eyes were diagnosed as glaucoma suspect.

    Among children with aphakia, the risk of a glaucoma-related AE was higher in those who were 3 months or younger at the time of surgery, had an abnormal anterior segment, experienced intraoperative complications, and had bilateral aphakia.

    Glaucoma surgery was performed in 7% of aphakic eyes and in .5% of pseudophakic eyes. VA at the five-year mark varied according to subgroup: for instance, in those who developed glaucoma, median VA was 20/80 for the 41 eyes with bilateral aphakia and 20/50 for the 17 eyes with unilateral aphakia. In those who had no glaucoma or ocular complications, median VA was 20/63 in 109 eyes with bilateral aphakia and 20/200 in 85 eyes with unilateral aphakia.

    All told, the researchers wrote, the findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age. (Also see related commentary by Eric Crouch, MD, in the same issue.)

    The original article can be found here.