1
|
Schmidt DC, Eriksson F, Bach-Holm D, Grønskov K, Kessel L. Long-term risk of glaucoma after cataract surgery in childhood. Acta Ophthalmol 2024. [PMID: 38233733 DOI: 10.1111/aos.16636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/03/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
PURPOSE To examine the long-term risk of glaucoma after cataract surgery in childhood. METHODS This study took place from January 2022 until December 2022 and included patients from a large family with hereditary childhood cataract who had cataract surgery before 18 years of age. Patients underwent an ophthalmologic examination to determine the presence of glaucoma or ocular hypertension (OHT). Patients who did not want to participate in the examination could contribute with a medical journal from their treating ophthalmologist. The risk of long-term glaucoma was determined using survival analysis, and risk factors were assessed using a Cox proportional hazards regression model. RESULTS We included 68 patients (133 eyes) with a median age at cataract surgery of 7 years (IQR: 5-10). The median follow-up time after cataract surgery to glaucoma/OHT or the latest ophthalmologic examination was 35 years (IQR: 15-48). Twelve patients (18 eyes) had glaucoma, and five patients (eight eyes) had OHT, resulting in 15 patients with glaucoma/OHT. The long-term risk of glaucoma/OHT diagnosed in adulthood was 47.7% (CI: 21.8-70.9) at the age of 70 years of patients who were free of glaucoma before their 18th year. We could not confirm or dismiss an association between glaucoma/OHT and sex, age at surgery, number of ocular interventions before 18 years of age or glaucoma after cataract surgery in a first-degree relative. CONCLUSION Cataract surgery in childhood is associated with a high risk of late-onset glaucoma. Regular lifelong follow-up is important to ensure early diagnosis and prevent extensive vision loss.
Collapse
Affiliation(s)
- Diana Chabané Schmidt
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Frank Eriksson
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karen Grønskov
- Department of Clinical Genetics, Centre of Diagnostic Investigations, Kennedy Centre, Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Belitsky Y, Magnusson G, Nyström A, Zetterberg M, Kalaboukhova L. Late-onset glaucoma following congenital cataract surgery: Occurrence, visual acuity and risk factors: A 37-year longitudinal follow-up. Acta Ophthalmol 2023; 101:170-176. [PMID: 36036699 DOI: 10.1111/aos.15241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 06/11/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to determine the prevalence of late-onset glaucoma after surgery for congenital cataract in a cohort with long-term follow-up and to evaluate visual development following the diagnosis of postoperative glaucoma in comparison with no glaucoma development. METHODS All children born between 1980 and 1997 in the western counties of Sweden who had undergone congenital cataract surgery were included (patients n = 77, eyes n = 122). Cataract was considered congenital if there was no proof of clear lens at birth. Medical records were reviewed with regard to onset of glaucoma, age at surgery, surgical technique, coexisting eye anomalies and changes in visual acuity. Glaucoma was considered late onset if occurring after 1 year following surgery. RESULTS Total glaucoma prevalence was 14.8%, including late (10.7%) and early onset (4.1%), with a mean follow-up of 23.2 ± 6.6 years. Microphthalmos was a significant risk factor for developing glaucoma (RR 7.75, p < 0.001). Bilaterally treated eyes had a mean visual acuity of 0.43 ± 0.33 (decimal value) at the last follow-up. With glaucoma, mean visual acuity was 0.19 ± 0.17 (decimal value). Treated eyes of patients with unilateral cataract surgery had a lower visual acuity. CONCLUSIONS Life-long follow-up of all patients who have undergone surgery for congenital cataract in childhood is recommended. Annual check-ups of adults, including measurements of IOP and visual acuity, are recommended for patients with microphthalmos and/or who had surgery <3 months of age.
Collapse
Affiliation(s)
- Yuri Belitsky
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Gunilla Magnusson
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alf Nyström
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Madeleine Zetterberg
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lada Kalaboukhova
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
3
|
Sand MK, Cholidis S, Kristianslund O, Drolsum L. Bag-in-the-lens intraocular lens implantation before 12 weeks of age in congenital cataract. Acta Ophthalmol 2023. [PMID: 36808711 DOI: 10.1111/aos.15647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/20/2023]
Abstract
PURPOSE The aim of this study was to evaluate the intra- and postoperative complications, especially the risk of visual axis opacification (VAO), following the implantation of the bag-in-the-lens (BIL) intraocular lens (IOL) in infants with congenital cataract operated on before 12 weeks of age. METHODS Infants operated on before 12 weeks of age between June 2020 and June 2021 with a follow-up longer than 1 year were included in the present retrospective study. This was a first-experience cohort of an experienced paediatric cataract surgeon with this type of lens. RESULTS Nine infants (13 eyes) with a median age at surgery of 28 days (range, 21-49 days) were included. The median follow-up time was 21.6 months (range, 12.2-23.4 months). The lens was correctly implanted with the anterior and posterior capsulorhexis edges placed into the interhaptic groove of the BIL IOL in seven of 13 eyes; none of these eyes developed VAO. In the remaining six eyes, the IOL was only fixated to the anterior capsulorhexis edge, and in these cases, an anatomical anomaly of the posterior capsule and/or anterior vitreolenticular interface dysgenesis were observed. These six eyes developed VAO. One eye had a partial iris capture in the early postoperative phase. Otherwise, the IOL remained well centred and stable in all eyes. Anterior vitrectomy was necessary in seven eyes due to vitreous prolapse. One patient with unilateral cataract was diagnosed with bilateral primary congenital glaucoma at 4 months of age. CONCLUSION Implantation of the BIL IOL is safe even in the youngest age group less than 12 weeks of age. Although being a first-experience cohort, the BIL technique is shown to reduce the risk of VAO and the number of surgical procedures.
Collapse
Affiliation(s)
- Mari Kathrine Sand
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Symira Cholidis
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Zhang Y, Song Y, Zhou Y, Bai B, Zhang X, Chen W. A Comprehensive Review of Pediatric Glaucoma Following Cataract Surgery and Progress in Treatment. Asia Pac J Ophthalmol (Phila) 2023; 12:94-102. [PMID: 36706336 DOI: 10.1097/apo.0000000000000586] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/01/2022] [Indexed: 01/29/2023] Open
Abstract
Glaucoma following cataract surgery (GFCS) remains a serious postoperative complication of pediatric cataract surgery. Various risk factors, including age at lensectomy, intraocular lens implantation, posterior capsule status, associated ocular/systemic anomaly, additional intraocular surgery, and a family history of congenital cataract and GFCS, have been reported. However, the optimal surgical approach remains unclear. This review evaluates the diagnostic criteria, classification, risk factors, mechanism, and surgical management, especially the efficacy of minimally invasive glaucoma surgery, in GFCS, and aims to propose an optimal clinical management strategy for GFCS. The results of our review indicate that ab interno trabeculotomy (goniotomy) may be the most appropriate first-line treatment for GFCS.
Collapse
Affiliation(s)
- Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China
| | | | | | | | | | | |
Collapse
|
5
|
Sand MK, Cholidis S, Kristianslund O, Drolsum L. Primary intraocular lens implantation in infants with unilateral congenital cataract operated before 12 weeks of age. Acta Ophthalmol 2022; 100:526-533. [PMID: 35411695 DOI: 10.1111/aos.15155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to report visual outcome and safety after cataract surgery with primary intraocular lens implantation before 12 weeks of age. METHODS Infants with visually significant unilateral congenital cataract having primary IOL implantation in the capsular bag before 12 weeks of age in 2007-2016 were enrolled for a prospective study examination in 2017. The medical records were also reviewed. RESULTS In total, 23 patients with a median age at cataract surgery of 32 days (range, 12-75 days) were included. Seventeen (74%) eyes had persistent foetal vasculature (PFV). After a median follow-up of 6.3 years (range, 1.4-10.9 years), the corrected distance visual acuity was 0.8 logMAR (range, 3.0-0.1 logMAR). All, except one eye, required surgery for visual axis opacification (VAO), with a median of two (range 0-5) additional surgical procedures. Four (17%) eyes developed secondary glaucoma. CONCLUSION Cataract surgery with primary IOL implantation before 12 weeks of age resulted in a high number of VAO operations, and the visual outcome varied considerably, showing the range in outcome for this challenging patient group. Co-existent PFV in these young patients was common. The incidence of secondary glaucoma was similar to other studies, despite the young age at surgery, high percentage of PFV and number of surgical procedures for VAO.
Collapse
Affiliation(s)
- Mari Kathrine Sand
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Symira Cholidis
- Department of Ophthalmology Oslo University Hospital Oslo Norway
| | - Olav Kristianslund
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Liv Drolsum
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| |
Collapse
|
6
|
Boonstra N, Haugen OH. Bag-in-the-lens intraocular lens in paediatric cataract surgery: intraoperative and postoperative outcomes. Acta Ophthalmol 2022; 100:e135-e141. [PMID: 33949791 DOI: 10.1111/aos.14878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/27/2021] [Accepted: 04/04/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To report intra- and postoperative surgical outcome using the bag-in-the-lens (BIL) technique in paediatric cataract surgery. METHODS In a retrospective case series, we studied the outcomes of children aged <12 years operated for cataract with the bag-in-the-lens intraocular lens (IOL), with a minimum of 6 months of follow-up. RESULTS Since 2013, 50 eyes in 30 patients <12 years (20 bilateral and 10 unilateral) have been operated at our department with the BIL technique, with a median follow-up time of 33.5 months (range 6-77). Median age at surgery was 49.5 months (4-139). In one case, the IOL luxated through the capsulorhexes to the vitreous, but could be secured and repositioned as planned without further difficulties. Anterior vitrectomy was necessary in one case due to prolapse of vitreous to the anterior chamber during surgery. No other intraoperative complications occurred. Visual axis opacification (VAO) developed in four eyes (8%). So far, only one of these has needed a reoperation with clearing of the secondary cataract. A complete absence of VAO was thus seen throughout the study period in 92%. In two eyes, postoperative iris capture occurred. In both cases, surgical repositioning of the iris was needed. No eyes developed secondary glaucoma during the study period. CONCLUSION The BIL technique seems to be a safe surgical procedure in paediatric cataract, with significantly less complications and need for additional surgery compared with the conventional lens-in-the-bag technique.
Collapse
Affiliation(s)
| | - Olav H. Haugen
- Department of Ophthalmology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine K1 Faculty of Medicine University of Bergen Bergen Norway
| |
Collapse
|
7
|
Guo J, Dong Q, Liu M. Effect of Intraocular Lens Biomaterials on the Treatment of Primary Angle Closure Glaucoma. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To explore the effect of phacoemulsification along with intraocular lens (IOL) implantation on the treatment of primary angle closure glaucoma (PACG), a total of 50 patients (54 eyes) with PCG who had undergone surgery were selected as the research objects, in which, there were 16 eyes
with the acute PACG in pre-clinical stage, 20 eyes with acute PACG during acute attack, and 18 eyes with chronic PACG, and all patients received phacoemulsification along with IOL implantation therapy. The patient’s best corrected visual acuity, anterior chamber (AC), anterior depth,
intraocular pressure (IOP), visual field, and fundus conditions were measured during the operation, after the operation, and during the follow-up period. The postoperative visual acuity of the patients with three types of PACG was greatly corrected, in which 30 eyes had corrected visual acuity
above 0.5, and there were statistically significant differences (SSDs) (P < 0.05); angle closure of 54 eyes had different degrees of improvement, the opening degree of the acute angle closure is better than that of the chronic angle closure, and there were SSDs (P < 0.05);
each of 54 eyes showed different degrees of deepening in the central AC, and there were SSDs (P < 0.05); postoperative IOP decreased greatly in all 54 eyes, and there were SSDs (P < 0.05). In conclusion, the IOL implantation based on phacoemulsification can effectively
treat the PACG, at the same time reduce IOP, promote angle opening, enhance vision field of the patients, and ultimately achieve the purpose of improving surgical success.
Collapse
Affiliation(s)
- Jianlian Guo
- Department of Ophthalmology, Lixia People’s Hospital of Jinan, Jinan, 250000, Shandong, China
| | - Qiang Dong
- Department of Ophthalmology, Lixia People’s Hospital of Jinan, Jinan, 250000, Shandong, China
| | - Min Liu
- Department of Ophthalmology, Lixia People’s Hospital of Jinan, Jinan, 250000, Shandong, China
| |
Collapse
|
8
|
Van Os L, Hildebrand GD, Tassignon MJ. Adapted Bag-in-the-Lens Implantation Technique in Children with Congenital Ectopia Lentis. Klin Monbl Augenheilkd 2021; 238:1058-1064. [PMID: 34662920 DOI: 10.1055/a-1633-4316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Subluxation of the crystalline lens in childhood confronts the surgeon with a dilemma: to operate or to wait and see. Surgery is usually not performed when the subluxation is still limited. However, postponing the surgery increases the surgical difficulty as the capsular bag becomes more difficult to use as a means of support for the intraocular lens (IOL). A large number of children already present a pronounced subluxation at first presentation. In this paper, we describe a technique to optimise centration and fixation of the bag-in-the-lens (BIL) IOL in children younger than 7 years of age with congenital ectopia lentis. METHODS Between October 2019 and December 2020, we performed lens extraction using a combination of bean-shaped segments to support the BIL IOL and a 6 - 0 polypropylene loop fixated at the sclera, following the Yamane technique, for the purpose of centration. We used this technique for seven eyes of four patients. The patients were between 2 and 6 years old; 3 boys and 1 girl. A definite diagnosis of Marfan syndrome was made for two children; for the other two, there was no proven underlying pathology. The luxation was upwards in all cases. The degree of luxation was severe in all eyes. The preoperative refraction values showed high astigmatism values for all eyes, ranging from 6.5 to 11.25 dioptres. Three out of the four patients were myopic, ranging from - 1.5 to - 9 dioptres. RESULTS The surgery could be performed without major complications in all eyes. Good centration was obtained, which remained stable in the postoperative period. Refraction improved with greatly diminished degrees of astigmatism (ranging from 0.25 to 3 dioptres) and myopia (spheres ranging from - 2 to + 1.75 dioptres). CONCLUSION Our novel technique incorporated the BIL technique with the addition of bean-shaped segments and a polypropylene 6/0 suture fixated at the sclera. In this way, we were able to obtain good centration and stability of the implanted IOL, as well as a good refractive outcome in all cases.
Collapse
Affiliation(s)
- Luc Van Os
- Ophthalmology, University Hospital Antwerp, Edegem, Belgium.,Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Göran Darius Hildebrand
- Paediatric ophthalmology, Oxford Eye Hospital, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Marie-José Tassignon
- Ophthalmology, University Hospital Antwerp, Edegem, Belgium.,Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
9
|
Nyström A, Haargaard B, Rosensvärd A, Tornqvist K, Magnusson G. The Swedish National Pediatric Cataract Register (PECARE): incidence and onset of postoperative glaucoma. Acta Ophthalmol 2020; 98:654-661. [PMID: 32274899 DOI: 10.1111/aos.14414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim was to report cumulative incidence and time of onset of postoperative glaucoma in a paediatric early cataract surgery cohort. METHODS Data were retrieved from the Pediatric Cataract Register (PECARE), a prospective register of Swedish cataract operations before 8 years of age. All eyes with surgery between January 2007 and December 2014 and a registered follow-up were included. Cataracts caused by uveitis, trauma or coexisting congenital glaucoma were excluded. Glaucoma was defined as early onset if diagnosed within a year after surgery and late onset if diagnosed later. RESULTS The study included 288 eyes in 207 children (106 girls), 81 with bilateral and 126 with unilateral cataracts, with a mean follow-up of 3.31 ± 1.77 years. Of the 288, 168 (58.3%) had surgery before 3 months of age; most of these 92.3% (155/168) were defined as dense, 208 (72.2%) were below 1 year of age. Cumulative incidence of surgically treated glaucoma among individuals was 23.7% (49/207). Median time to glaucoma onset was 0.91 years (range: 0.05-4.97 years) for eyes. Early-onset glaucoma was found in 98 % (63/64), and late onset in 2% (1/64). CONCLUSION In this paediatric cataract cohort, a majority of eyes had surgery before 3 months of age (58.3%). Secondary glaucoma-onset peaked within the first postoperative year, with a cumulative incidence of 23.7%. Surgery performed after the first month of life, resulted in a lower glaucoma rate. Long-term follow-up will reveal whether the low rate of late-onset glaucoma with early surgery will last, and if so, the consequences.
Collapse
Affiliation(s)
- Alf Nyström
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | | | - Annika Rosensvärd
- Division of Ophthalmology and Vision Department of Clinical Neuroscience Karolinska Institute St Erik Eye Hospital Stockholm Sweden
| | - Kristina Tornqvist
- Department of Clinical Sciences Ophthalmology Lund University Lund Sweden
| | - Gunilla Magnusson
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| |
Collapse
|