1
|
Nihalani BR, VanderVeen DK. Timing of Diagnosis and Treatment of Glaucoma following Infantile Cataract Surgery. Ophthalmol Glaucoma 2024; 7:290-297. [PMID: 38104771 DOI: 10.1016/j.ogla.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To report timing of diagnosis and treatment of glaucoma following cataract surgery (GFCS) in a large cohort of infants undergoing cataract surgery at a tertiary care center. STUDY DESIGN Cross-sectional study. PARTICIPANTS All consecutive infants that underwent cataract surgery over a 30-year period from January 1991 to December 2021 were included if they had at least 1 year follow-up. METHODS The data collection included age at time of cataract surgery, presence of associated ocular or systemic conditions, age at diagnosis of GFCS, and treatment required to control GFCS. Glaucoma diagnosis required intraocular pressure (IOP) > 21 mmHg on > 2 visits with glaucomatous optic nerve head changes and/or visual field changes, or in young children, other anatomic changes such as corneal enlargement or haze or accelerated axial elongation and myopic shift. MAIN OUTCOME MEASURES The incidence of GFCS was calculated. Linear regression was performed to assess the effect of age at time of cataract surgery. Analysis of risk factors and treatment modalities was performed using univariate and multivariate analysis. RESULTS Three hundred eighty-three eyes (260 patients) were analyzed. Median age at surgery was 52 days and median follow-up, 8 years. Glaucoma following cataract surgery was noted in 27% (104/383 eyes; median age at surgery, 45 days; median follow-up, 13 years.) Young age at surgery (< 3 months) was the greatest risk factor (P = 0.001) but the incidence was similar for infants operated in the first, second, or third month of life (25%, 36%, 40%, respectively, P = 0.4). Microcornea (41%, P < 0.0001), poorly dilating pupils (25%, P = 0.001), persistent fetal vasculature (PFV, 13%; P = 0.8), or anterior segment dysgenesis (3%, P = 0.02) were considered as additional risk factors. Surgical intervention was needed for 73% (24/33) eyes with early-onset GFCS compared with 14% (10/71) eyes with later-later onset GFCS (P < 0.0001). Medical treatment was effective in 86% with later-onset GFCS (P = 0.006). CONCLUSIONS The incidence of GFCS was 27%, and timing of diagnosis occurred in a bimodal fashion. Early-onset GFCS usually requires surgical intervention; medical treatment is effective for later-onset GFCS. Cataract surgery within the first 3 months of life, microcornea, and poorly dilating pupils were major risk factors. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Bharti R Nihalani
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | | |
Collapse
|
2
|
Dericioğlu V, Sevik MO, Bağatur Vurgun E, Çerman E. Predictive Factors of Complications and Visual Outcomes after Pediatric Cataract Surgery: A Single Referral Center Study from Türkiye. Turk J Ophthalmol 2023; 53:267-274. [PMID: 37867431 PMCID: PMC10599340 DOI: 10.4274/tjo.galenos.2023.50951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/26/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives To evaluate the predictive factors of complications and visual acuity outcomes in pediatric cataract patients. Materials and Methods This retrospective, observational clinical study included 80 eyes of 50 patients treated for pediatric cataracts between 2010 and 2020. The eyes were divided into Group I (congenital cataracts, n=38) and Group II (developmental cataracts, n=42). Group II was also divided into Group IIA (aphakic, n=21) and Group IIB (pseudophakic, n=21). The effects of the age, laterality, cataract morphology, intraocular lens implantation, preoperative nystagmus/strabismus, and intraoperative anterior hyaloid rupture on complications and final best-corrected visual acuity (BCVA; logMAR) were evaluated. Results The median (interquartile range) age and follow-up time were 28 (5-79) months and 60 (29-84) months, respectively. There was a significant difference in mean final BCVA between Group I (0.79±0.46) and Group II (0.57±0.51) (p=0.047); however, no difference was observed between Group IIA and Group IIB (p=0.541). Having congenital cataract (p=0.045), preoperative nystagmus/strabismus (p=0.042), total/mature cataract (p<0.001), and postoperative complications (p=0.07) were significantly associated with final BCVA. However, in multivariate analysis, only total/mature cataract (β: 0.52, p<0.001) and having any complication (β: 0.24, p=0.018) were associated with final BCVA. Congenital cataract and intraoperative anterior hyaloid rupture were the only significant risk factors of postoperative complications on univariate (p=0.027 and p=0.003, respectively) and binary logistic regression analysis (odds ratio [OR]: 2.95 [95% confidence interval: 1.07-8.15], p=0.036 and OR: 4.28 [95% confidence interval: 1.55-11.77], p=0.005, respectively). Conclusion Total/mature cataract and the presence of any postoperative complication adversely affected the final BCVA. Having a congenital cataract and intraoperative anterior hyaloid membrane rupture increased the risk of complications.
Collapse
Affiliation(s)
- Volkan Dericioğlu
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Mehmet Orkun Sevik
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Elif Bağatur Vurgun
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Eren Çerman
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| |
Collapse
|
3
|
Ugalahi M, Adediran O, Olusanya B, Baiyeroju A. Management of childhood cataract: practice patterns among ophthalmologists in Nigeria. Eye (Lond) 2023:10.1038/s41433-023-02755-x. [PMID: 37749375 DOI: 10.1038/s41433-023-02755-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE To describe the practice patterns for the management of paediatric cataracts among ophthalmologists practising in Nigeria. METHODS A cross-sectional study of fully trained Nigerian ophthalmologists who perform cataract surgery in children aged 16 years and below. An online questionnaire was distributed via e-mail and social media platforms to respondents. Data on socio-demographic characteristics, type, location and years of practice, status and preferred approach to management of childhood cataracts were obtained and analysed. RESULTS A total of 41 ophthalmologists responded that they perform paediatric cataract surgery. Of these, 25 (61.0%) were paediatric ophthalmologists while 7 (17.0%) were general ophthalmologists. Most respondents (92.7%) practise in urban settings and 30 (73.2%) work in tertiary hospitals. Most respondents (90.2%) routinely insert intraocular lenses (IOLs) in children aged 2 years and above while 32 (78.0%) routinely under-correct the IOL power. Thirty-four (82.9%) have an anterior vitrectomy machine, 31 (75.6%) routinely perform posterior capsulotomy and anterior vitrectomy, and 17 (58.5%) routinely perform same-day sequential bilateral cataract surgery. Twenty-six (63.4%) respondents routinely give near correction in aphakic children, while 24 (58.5%) respondents routinely give bifocals in pseudophakic children. Compared to other sub-specialists, paediatric ophthalmologists were 24 times more likely to routinely under-correct IOL power (p = 0.001) and 4 times more likely to routinely correct near vision in aphakic children (0.036) as well as prescribe bifocals for pseudophakic children respectively (0.029). CONCLUSION The practice of paediatric cataract surgery in Nigeria is mainly in line with expected standards, but there is a need for the development of detailed practice guidelines.
Collapse
Affiliation(s)
- Mary Ugalahi
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | - Bolutife Olusanya
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria.
| | - Aderonke Baiyeroju
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| |
Collapse
|
4
|
Wood A, Lim B, Matthews J, Karaconji T, Zagora SL, Jamieson RV, Grigg JR, Jones M, Rowe N, Hing S, Donaldson C, Smith JEH. Prevalence of Glaucoma Following Paediatric Cataract Surgery in an Australian Tertiary Referral Centre. Clin Ophthalmol 2023; 17:2171-2179. [PMID: 37547173 PMCID: PMC10402721 DOI: 10.2147/opth.s400512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose Secondary glaucoma following childhood cataract surgery remains the most common complication in the paediatric population. This study aimed to determine the incidence, time to progression and risk factors associated with the development of secondary glaucoma following childhood cataract surgery in a paediatric population. Outcome measures were the detection of secondary glaucoma, postoperative time frame to development of glaucoma and risk factors in its development. Patients and Methods A retrospective case series was conducted between 2003 and 2017 at a tertiary children's hospital in Sydney. The patient population included those 16 years or less of age who underwent congenital cataract extraction, with or without an intraocular lens implantation and who had been followed up for a minimum of six months following surgery. Patients were excluded if they had cataract aetiology other than congenital idiopathic cataract. Multivariate Cox Regression analysis was used to determine relevant risk factors. Results A total of 320 eyes in 216 patients were included in the study. Secondary glaucoma developed in 11.9% of eyes. In those that developed secondary glaucoma, the average time to onset from surgery was 3.2 years (median 2.75 years). The mean age of diagnosis of secondary glaucoma was 4.58 years (median 3.5 years, range 2.5 months to 13.23 years). Microcornea was the only adverse characteristic significantly associated with an increased risk of secondary glaucoma (HR 6.30, p 0.003). Conclusion Despite modern surgical techniques, glaucoma remains a significant long-term sequela in children following cataract surgery.
Collapse
Affiliation(s)
- Alanna Wood
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Benjamin Lim
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Jim Matthews
- Sydney Informatics Hub, The University of Sydney, Sydney, NSW, Australia
| | - Tanya Karaconji
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Sophia L Zagora
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
- Eye Genetics Research, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW, Australia
- Disciplines of Genetic Medicine, and Child and Adolescent, Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - John R Grigg
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
- Eye Genetics Research, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Michael Jones
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Neil Rowe
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Stephen Hing
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Craig Donaldson
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - James E H Smith
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| |
Collapse
|
5
|
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
|
6
|
Choe S, Ha A, Choi S, Baek SU, Kim JS, Jeoung JW, Park KH, Kim YK. Nationwide Incidence of Infantile Cataract Surgery and Risk of Secondary Glaucoma in a Population-based Birth Cohort. Am J Ophthalmol 2023; 246:130-140. [PMID: 36328202 DOI: 10.1016/j.ajo.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To determine the nationwide birth cohort incidence of infantile cataract (IC) surgery and the risk of secondary glaucoma in a Korean population. DESIGN A population-based, retrospective cohort study. METHODS We accessed the Korean National Health Claims database to identify patients with IC who were diagnosed before 1 year of age and who underwent IC surgery among all Koreans born between 2008 and 2018 (n = 9,593,003). We estimated IC surgery incidence in a birth cohort. The incidence rates of post-IC surgery glaucoma were estimated per 100 person-years, based on the Poisson distribution. The risk factors for post-IC surgery glaucoma, including ophthalmic and systemic comorbidities, were analyzed by multivariable logistic regression analysis. RESULTS During the 11-year study period, 692 patients underwent IC surgery. The annual birth cohort incidence of IC surgery in the general population ranged from 5.10 to 9.29 cases per 100,000 individuals. Among patients who had been followed up for longer than 1 year (n = 650), 92 (14.2%) developed glaucoma, and its incidence rate was 2.29 (95% confidence interval, 1.86-2.80) per 100 person-years. The mean time from IC surgery to glaucoma development was 4.7 ± 3.5 years. No factors were identified as being associated with post-IC surgery glaucoma risk other than primary or secondary intraocular lens implantation, which reduces the risk (all P < .05). In patients without primary intraocular lens implantation, the risk of glaucoma increased steeply during the first 2 years after IC surgery. CONCLUSION This study identified the birth cohort incidence of IC surgery and secondary glaucoma risk in individuals of East Asian ethnicity. These estimates may help to better understand the epidemiologic features and clinical courses of patients with IC.
Collapse
Affiliation(s)
- Sooyeon Choe
- From the Department of Ophthalmology (S.Choe, J.W.J., K.H.P., Y.K.K.), Seoul National University College of Medicine, Seoul; Departments of Ophthalmology (S.Choe, J.W.J., K.H.P., Y.K.K.), Seoul National University Hospital, Seoul
| | - Ahnul Ha
- Departments of Ophthalmology at Jeju National University Hospital and Jeju National University College of Medicine (A.H.).
| | - Seulggie Choi
- Internal Medicine (S. Choi), Seoul National University Hospital, Seoul
| | - Sung Uk Baek
- Jeju-si; Departments of Ophthalmology at Hallym University College of Medicine, Chuncheon; Hallym University Sacred Heart Hospital (S.U.B.), Anyang
| | - Jin-Soo Kim
- Department of Ophthalmology (J-S.K.), Chungnam National University Sejong Hospital, Sejong
| | - Jin Wook Jeoung
- From the Department of Ophthalmology (S.Choe, J.W.J., K.H.P., Y.K.K.), Seoul National University College of Medicine, Seoul; Departments of Ophthalmology (S.Choe, J.W.J., K.H.P., Y.K.K.), Seoul National University Hospital, Seoul
| | - Ki Ho Park
- From the Department of Ophthalmology (S.Choe, J.W.J., K.H.P., Y.K.K.), Seoul National University College of Medicine, Seoul; Departments of Ophthalmology (S.Choe, J.W.J., K.H.P., Y.K.K.), Seoul National University Hospital, Seoul
| | - Young Kook Kim
- From the Department of Ophthalmology (S.Choe, J.W.J., K.H.P., Y.K.K.), Seoul National University College of Medicine, Seoul; Departments of Ophthalmology (S.Choe, J.W.J., K.H.P., Y.K.K.), Seoul National University Hospital, Seoul; Department of Pediatric Ophthalmology (Y.K.K.), Seoul National University Children's Hospital, Seoul; EyeLight Data Science Laboratory (Y.K.K.), Seoul, Korea.
| |
Collapse
|
7
|
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
|
8
|
Arbisser LB. Review of primary posterior capsulorhexis in cataract surgery. Saudi J Ophthalmol 2022; 36:149-156. [PMID: 36211323 PMCID: PMC9535914 DOI: 10.4103/sjopt.sjopt_183_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/14/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022] Open
Abstract
This article reviews the history and technique of primary posterior capsulorhexis with emphasis on anterior hyaloid membrane preservation and combined posterior optic capture of intraocular lenses into Berger's space for the purpose of lens stability and secondary cataract elimination among other potential advantages. Applications, variations, efficacy, and safety of the procedure are reviewed.
Collapse
Affiliation(s)
- Lisa B. Arbisser
- Moran Eye Center, University of Utah, Salt Lake City, Utah, USA,Address for correspondence: Prof. Lisa B. Arbisser, 644 Beach Rd, Sarasota, Florida 34242, USA. E-mail:
| |
Collapse
|
9
|
Zhang Z, Fu Y, Wang J, Ji X, Li Z, Zhao Y, Chang P, Zhao YE. Glaucoma and risk factors three years after congenital cataract surgery. BMC Ophthalmol 2022; 22:118. [PMID: 35279111 PMCID: PMC8918280 DOI: 10.1186/s12886-022-02343-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aimed to identify the incidence of and risk factors for postoperative glaucoma-related adverse events at various time points after congenital cataract surgery.
Methods
This retrospective cohort study enrolled 259 eyes from 174 patients (surgical age ≤ 7 years) who underwent congenital cataract surgery. All surgical procedures were conducted at the Eye Hospital of Wenzhou Medical University between May 2011 and March 2019. Patients were classified into group 1 [primary intraocular lens (IOL) implantation, N = 111 eyes], group 2 (secondary IOL implantation, N = 85 eyes), and group 3 (no IOL implantation, N = 63 eyes). We recorded demographic factors and incidence and risk factors for glaucoma-related adverse events.
Results
Glaucoma-related adverse events occurred in 21 (8.1%) eyes, whereas 27 (10.4%) eyes developed steroid-induced ocular hypertension. The percentage of glaucoma-related adverse events was 0%, 1.2%, 1.2%, 1.6%, 4.0%, and 8.9% at 1 month, 6 months, 1 year, 2 years, 3 years and 4 years after surgery, respectively. Sixteen (18.8%), five (7.9%), and zero eyes developed glaucoma-related adverse events in groups 2, 3, and 1, respectively. Family history of congenital cataract [hazard ratio (HR), 50.463; 95% confidence interval (CI), 7.051–361.139; P < 0.001], preoperative central corneal thickness (CCT) [HR, 1.021; 95% CI, 1.009–1.034; P = 0.001], preoperative horizontal corneal diameter (HCD) [HR, 3.922; 95% CI, 1.558–9.804; P = 0.004], and preoperative lens thickness (LT) [HR, 3.745; 95% CI, 1.344–10.417; P = 0.012] were identified as predictors of postoperative glaucoma-related adverse events.
Conclusions
Family history of congenital cataract, thicker preoperative CCT, smaller preoperative HCD, and thinner preoperative LT are the main risk factors of postoperative glaucoma-related adverse events. Regular monitoring of children after cataract surgery with these risk factors may help ophthalmologists detect susceptible individuals and provide timely interventions in the clinic.
Collapse
|
10
|
Simons AS, Casteels I, Grigg J, Stalmans I, Vandewalle E, Lemmens S. Management of Childhood Glaucoma Following Cataract Surgery. J Clin Med 2022; 11:jcm11041041. [PMID: 35207320 PMCID: PMC8879979 DOI: 10.3390/jcm11041041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
Glaucoma remains a frequent serious complication following cataract surgery in children. The optimal approach to management for 'glaucoma following cataract surgery' (GFCS), one of the paediatric glaucoma subtypes, is an ongoing debate. This review evaluates the various management options available and aims to propose a clinical management strategy for GFCS cases. A literature search was conducted in four large databases (Cochrane, PubMed, Embase, and Web of Science), from 1995 up to December 2021. Thirty-nine studies-presenting (1) eyes with GFCS; a disease entity as defined by the Childhood Glaucoma Research Network Classification, (2) data on treatment outcomes, and (3) follow-up data of at least 6 months-were included. Included papers report on GFCS treated with angle surgery, trabeculectomy, glaucoma drainage device implantation (GDD), and cyclodestructive procedures. Medical therapy is the first-line treatment in GFCS, possibly to bridge time to surgery. Multiple surgical procedures are often required to adequately control GFCS. Angle surgery (360 degree) may be considered before proceeding to GDD implantation, since this technique offers good results and is less invasive. Literature suggests that GDD implantation gives the best chance for long-term IOP control in childhood GFCS and some studies put this technique forward as a good choice for primary surgery. Cyclodestruction seems to be effective in some cases with uncontrolled IOP. Trabeculectomy should be avoided, especially in children under the age of one year and children that are left aphakic. The authors provide a flowchart to guide the management of individual GFCS cases.
Collapse
Affiliation(s)
- Anne-Sophie Simons
- Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; (I.C.); (I.S.); (E.V.); (S.L.)
- Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-16-34-62-28
| | - Ingele Casteels
- Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; (I.C.); (I.S.); (E.V.); (S.L.)
- Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - John Grigg
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, 8 Macquarie St., Sydney, NSW 2000, Australia;
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; (I.C.); (I.S.); (E.V.); (S.L.)
- Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Evelien Vandewalle
- Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; (I.C.); (I.S.); (E.V.); (S.L.)
- Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Sophie Lemmens
- Department of Ophthalmology, University Hospitals UZ Leuven, Herestraat 49, 3000 Leuven, Belgium; (I.C.); (I.S.); (E.V.); (S.L.)
- Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| |
Collapse
|
11
|
Carrabba N, Zhaver D, Blieden LS. Surgical Management of Secondary Pediatric Glaucoma. Int Ophthalmol Clin 2022; 62:111-130. [PMID: 34965230 DOI: 10.1097/iio.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Freedman SF, Beck AD, Nizam A, Vanderveen DK, Plager DA, Morrison DG, Drews-Botsch CD, Lambert SR. Glaucoma-Related Adverse Events at 10 Years in the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmol 2021; 139:165-173. [PMID: 33331850 DOI: 10.1001/jamaophthalmol.2020.5664] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Glaucoma-related adverse events constitute serious complications of cataract removal in infancy, yet long-term data on incidence and visual outcome remain lacking. Objective To identify and characterize incident cases of glaucoma and glaucoma-related adverse events (glaucoma + glaucoma suspect) among children in the Infant Aphakia Treatment Study (IATS) by the age of 10.5 years and to determine whether these diagnoses are associated with optic nerve head (ONH) and peripapillary retinal nerve fiber layer (RNFL) assessment. Design, Setting, and Participants Analysis of a multicenter randomized clinical trial of 114 infants with unilateral congenital cataract who were aged 1 to 6 months at surgery. Data on long-term glaucoma-related status and outcomes were collected when children were 10.5 years old (July 14, 2015, to July 12, 2019) and analyzed from March 30, 2019, to August 6, 2019. Interventions Participants were randomized at cataract surgery to either primary intraocular lens (IOL), or aphakia (contact lens [CL]). Standardized definitions of glaucoma and glaucoma suspect were created for IATS and applied for surveillance and diagnosis. Main Outcomes and Measures Development of glaucoma and glaucoma + glaucoma suspect in operated-on eyes up to age 10.5 years, plus intraocular pressure, axial length, RNFL (by optical coherence tomography), and ONH photographs. Results In Kaplan-Meier analysis, for all study eyes combined (n = 114), risk of glaucoma after cataract removal rose from 9% (95% CI, 5%-16%) at 1 year, to 17% (95% CI, 11%-25%) at 5 years, to 22% (95% CI, 16%-31%) at 10 years. The risk of glaucoma plus glaucoma suspect diagnosis after cataract removal rose from 12% (95% CI, 7%-20%) at 1 year, to 31% (95% CI, 24%-41%) at 5 years, to 40% (95% CI, 32%-50%) at 10 years. Risk of glaucoma and glaucoma plus glaucoma suspect diagnosis at 10 years was not significantly different between treatment groups. Eyes with glaucoma (compared with eyes with glaucoma suspect or neither) had longer axial length but relatively preserved RNFL and similar ONH appearance and visual acuity at age 10 years. Conclusions and Relevance Risk of glaucoma-related adverse events continues to increase with longer follow-up of children following unilateral cataract removal in infancy and is not associated with primary IOL implantation. Development of glaucoma (or glaucoma suspect) after removal of unilateral congenital cataract was not associated with worse visual acuity outcomes at 10 years. Trial Registration ClinicalTrials.gov Identifier: NCT00212134.
Collapse
Affiliation(s)
- Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Allen D Beck
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | | | - David A Plager
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - David G Morrison
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carolyn D Drews-Botsch
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | | |
Collapse
|
13
|
|
14
|
Abdelmassih Y, Beaujeux P, Dureau P, Edelson C, Caputo G. Incidence and Risk Factors of Glaucoma Following Pediatric Cataract Surgery With Primary Implantation. Am J Ophthalmol 2021; 224:1-6. [PMID: 32950509 DOI: 10.1016/j.ajo.2020.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the incidence and risk factors for glaucoma after pediatric cataract surgery with intraocular lens (IOL) implantation. DESIGN Retrospective, consecutive case series. METHODS In this single-center study, we reviewed 136 children (199 eyes) who underwent pediatric cataract surgery before 1 year of age with a minimum of 1 year of follow-up. The intervention used was pediatric cataract surgery with IOL implantation, and the primary outcome measure was the presence or absence of secondary glaucoma. RESULTS The mean age at surgery was 148 ± 93 days (range 30-359 days) with a mean follow-up of 6.3 ± 3.6 years (range 1.1-12.8 years). Glaucoma developed in 31 eyes (16%) with 5- and 10-year incidence rates of 12% and 28%, respectively. The incidence of glaucoma seemed to be bimodal, with a first peak occurring after a mean delay of 2.5 months (range 1.6-4.1 months) and a second peak occurring after a mean delay of 5.7 years (range 2.6-11.7 years). Younger age at surgery, shorter axial length, longer follow-up, use of trypan blue, reintervention, and bilateral surgery were associatied with a higher incidence of glaucoma. Multivariate analysis including the aforementioned variables indentified longer follow-up (odds ratio [OR] = 1.3 [95% confidence interval {CI} 1.1-1.6], P = .001), reintervention (OR = 4.1 [95% CI 1.2-13.4], P = 0.02), and the use of trypan blue (OR = 4.1 [95% CI 1.3-13.1], P = .02) as predictors for the development of glaucoma. CONCLUSION Glaucoma is a common complication after pediatric cataract surgery. It seemed to have a bimodal incidence. Risk factors for glaucoma development were reintervention, the use of trypan blue, and a long follow-up.
Collapse
|
15
|
Jamerson EC, Solyman O, Yacoub MS, Abushanab MMI, Elhusseiny AM. Angle Surgery in Pediatric Glaucoma Following Cataract Surgery. Vision (Basel) 2021; 5:vision5010009. [PMID: 33562514 PMCID: PMC7930951 DOI: 10.3390/vision5010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/03/2022] Open
Abstract
Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of surgery, microcornea, and additional surgical interventions. The exact mechanism for GFCS has yet to be completely elucidated. While medical therapy is the first line for treatment of GFCS, many eyes require surgical intervention, with various surgical modalities each posing a unique host of risks and benefits. Angle surgical techniques include goniotomy and trabeculotomy, with trabeculotomy demonstrating increased success over goniotomy as an initial procedure in pediatric eyes with GFCS given the success demonstrated throughout the literature in reducing IOP and number of IOP-lowering medications required post-operatively. The advent of microcatheter facilitated circumferential trabeculotomies lead to increased success compared to traditional <180° rigid probe trabeculotomy in GFCS. The advent of two-site rigid-probe trabeculotomy indicated that similar results could be attained without the use of the more expensive microcatheter system. Further studies of larger scale, with increased follow-up, and utilizing randomization would be beneficial in determining optimum surgical management of pediatric GFCS.
Collapse
Affiliation(s)
- Emery C. Jamerson
- Department of Ophthalmology, Columbia University Irving Medical Center, Edward S. Harkness Eye Institute, New York, NY 10032, USA;
| | - Omar Solyman
- Department of Ophthalmology, Research Institute of Ophthalmology, Cairo 11261, Egypt; (O.S.); (M.M.I.A.)
| | - Magdi S. Yacoub
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo 11261, Egypt;
| | | | - Abdelrahman M. Elhusseiny
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo 11261, Egypt;
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| |
Collapse
|
16
|
Ben-Zion I, Prat D. The impact of late-treated pediatric cataract on intraocular pressure. Int Ophthalmol 2021; 41:1531-1539. [PMID: 33471248 DOI: 10.1007/s10792-021-01727-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the intraocular pressure and visual acuity before and after pediatric congenital cataract surgery performed at a relatively older age. METHODS A retrospective analysis of all consecutive pediatric patients diagnosed and operated for bilateral congenital cataracts during a seven-year period (2012-2018) in rural southern Ethiopia. Non-ambulatory vision was defined as hand motion or worse. The main outcome measures were intraocular pressure (IOP) and visual acuity. RESULTS Thirty-two children were included, 17 females (53.1%), with a mean age of 11 years (± 2.83) [range, 7-18]. A total of 59 eyes were operated on. The mean follow-up was 4.8 ± 1.8 years (range, 2-8). VA improved from 20/1400 preoperatively to 20/440 postoperatively OD and 20/540 OS (p < 0.001). More eyes had ambulatory vision after cataract surgery than pre-surgery (56 eyes [95%] vs. 29 eyes [49%], p < 0.001). The IOP decreased from a mean preoperative value of 18.4 ± 7.1 mmHg to 14.5 ± 2.9 postoperatively OD (p < 0.001) and 16.3 ± 5.9 mmHg to 13.9 ± 3.5 OS (p < 0.001). Fifteen eyes (24%) had increased IOP (> 21 mmHg) preoperatively, of which three remained high after surgery. Positive correlations were found between IOP, axial length and cup-to-disc ratio. None of the patients required pressure-lowering procedures. CONCLUSION Bilateral congenital cataracts may be associated with ocular hypertension, with possible progression to glaucoma if left untreated. Surgery at a relatively older age often was associated with a significant improvement in intraocular pressure and ambulatory vision.
Collapse
Affiliation(s)
- Itay Ben-Zion
- Ophthalmology Department, Padeh Medical Center, Poriya, Israel, affiliated With Bar-Ilan Faculty of Medicine, Safed, Israel.
| | - Daphna Prat
- Goldschleger Eye Institute, Faculty of Medicine, Sheba Medical Center, Tel Hashomer, Israel, affiliated With Sackler, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
17
|
Spiess K, Peralta Calvo J. Clinical Characteristics and Treatment of Secondary Glaucoma After Pediatric Congenital Cataract Surgery in a Tertiary Referral Hospital in Spain. J Pediatr Ophthalmol Strabismus 2020; 57:292-300. [PMID: 32956478 DOI: 10.3928/01913913-20200707-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/24/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze clinical characteristics, treatment, and long-term outcomes of pediatric patients with glaucoma after congenital cataract surgery at a single tertiary care hospital. METHODS Medical records of pediatric patients diagnosed as having glaucoma secondary to congenital cataract surgery between 1996 and 2016 were reviewed retrospectively. RESULTS A total of 58 eyes of 42 patients were included with a median follow-up time of 55 months (interquartile range [IQR]: 27 to 128) after glaucoma diagnosis. Mean time of glaucoma onset after cataract surgery was 35 months (IQR: 5 to 96). At diagnosis, 81% of the eyes were aphakic and the majority presented with an open angle (86%). Multivariate analysis demonstrated that glaucoma diagnosis was made earlier in eyes with persistent fetal vasculature (β = -0.334, P = .006) and aphakic eyes (β = 0.404, P = .001). Two-thirds of eyes required surgical treatment for glaucoma. Seventy percent had an Ahmed glaucoma valve (New World Medical, Inc) implantation as their primary procedure, followed by trabeculectomy (24%) and synechiolysis with peripheral iridotomy (6%). All medically treated eyes and 78% of the surgically treated eyes achieved intraocular pressure (IOP) control at the final visit. CONCLUSIONS Diagnosis of glaucoma after congenital cataract surgery seems to follow a bimodal distribution (years 1 and 5 after cataract surgery). Two-thirds of the eyes required surgical hypotensive treatment to achieve IOP control. Ahmed glaucoma valve implantation is a safe and effective surgical option to be considered as both first- and second-line treatment. Functional outcome was more favorable in those eyes with medically controlled glaucoma. [J Pediatr Ophthalmol Strabismus. 2020;57(5):292-300.].
Collapse
|
18
|
Surgical outcomes of cataract surgery in anterior and combined persistent fetal vasculature using a novel surgical technique: a single center, prospective study. Graefes Arch Clin Exp Ophthalmol 2020; 259:213-221. [PMID: 32803327 DOI: 10.1007/s00417-020-04883-6] [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: 02/05/2020] [Revised: 07/05/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To study the complications and surgical outcomes of cataract surgery in patients of persistent fetal vasculature (PFV) with cataract. METHODS In this prospective study, phacoaspiration with/without intraocular lens implantation (IOL) was done in 20 children (mean age 14.2 months) with unilateral cataract with anterior (n = 6) or combined (n = 14) PFV. The rentrolental vascularized membrane was cauterized and dissected circumferentially, followed by cauterization and resection of the PFV stalk. The outcome measures included fixation preference using the CSM (central, steady, maintained) method and intraoperative and postoperative complications in an 18-month follow-up. The difference in outcomes of anterior and combined PFV, as well as aphakic and pseudophakic eyes, was studied. RESULTS CSM fixation was seen in 16 patients after 18 months. The intraocular lens was implanted in 16 eyes and 4 eyes with combined PFV were left aphakic. None of our patients had intraoperative bleeding. Visual axis obscuration was the major complication seen, requiring membranectomy in 8 children. Pupilloplasty was required with membranectomy in one eye. None of our patients developed glaucoma or retinal detachment. CONCLUSION Timely surgical intervention and aggressive amblyopia therapy led to good visual results in our study. Poor prognosis was seen in combined PFV, aphakia, and microphthalmia.
Collapse
|
19
|
Spiess K, Peralta Calvo J. Outcomes of Ahmed glaucoma valve in paediatric glaucoma following congenital cataract surgery in persistent foetal vasculature. Eur J Ophthalmol 2020; 31:1070-1078. [PMID: 32354227 DOI: 10.1177/1120672120919066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the outcomes of primary Ahmed glaucoma valve in refractory secondary glaucoma following congenital cataract surgery, particularly in persistent foetal vasculature. METHOD Retrospective review of paediatric patients after Ahmed glaucoma valve implantation for refractory post-lensectomy glaucoma in a tertiary referral centre in Spain. Surgical complications, additional and/or replacements of Ahmed glaucoma valve, intraocular pressure, cup-to-disc ratio, glaucoma medications and final visual acuity were studied. RESULTS A total of 29 eyes, 41% with persistent foetal vasculature and 59% with non-persistent foetal vasculature were included with mean follow-up of 105 ± 67 and 74 ± 45 months, respectively, after first Ahmed glaucoma valve implant. Median survival time for the first Ahmed glaucoma valve was significantly lower in persistent foetal vasculature (7.0 ± 3.2 months) compared to non-persistent foetal vasculature (over 129 months), p = 0.001. The cumulative probability of success in persistent foetal vasculature and non-persistent foetal vasculature eyes with Ahmed glaucoma valve were, respectively, 37.5% and 88.2% at year 1 and 28.1% and 71.9% at year 5. Cox regression model suggested persistent foetal vasculature as predictive risk factor of time to Ahmed glaucoma valve failure (hazard ratio: 5.77, p = 0.004). Four eyes developed phthisis bulbi. Mean intraocular pressure prior glaucoma surgery was 32.66 ± 6.73 mmHg and decreased to 16.54 ± 2.75 mmHg (p < 0.001) at final visit. The most frequent early postoperative complication was severe hypotony (32.6%) which tended to be self-limiting. Vitreous haemorrhage was associated with persistent foetal vasculature (p = 0.024). Ahmed glaucoma valve replacements after complications and additional Ahmed glaucoma valve implantations due to unsatisfactory intraocular pressure were more common in the persistent foetal vasculature group. CONCLUSION Eyes with persistent foetal vasculature and secondary glaucoma after congenital cataract surgery followed by AGV implantation had a higher number of complications and a decreased probability of success compared to the non-persistent foetal vasculature group. Both groups achieved a significant decrease in intraocular pressure; thus, Ahmed glaucoma valve may be considered as first-line treatment in refractory glaucoma following congenital cataract surgery.
Collapse
|
20
|
Clinical and therapeutic particularities of congenital cataracts in pediatric patients with Down syndrome. Rom J Ophthalmol 2020; 64:168-175. [PMID: 32685783 PMCID: PMC7339686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: This study aims to identify clinical and therapeutic surgical particularities and postoperative complications encountered in children suffering from Down syndrome and congenital cataract, as well as the existence of a correlation with associated systemic anomalies. Methods: A retrospective interventional study that analyzes cases of congenital cataracts operated on a group of 14 children with Down syndrome, respectively on 26 eyes, was performed. The age of the children at the time of the surgery, the presence of associated ocular and systemic anomalies, the employed surgical technique, the frequency and the type of postoperative complications, were examined. Results: Cataracts present at birth, with recommendations for surgical treatment, were rare among children suffering from Down syndrome, but their frequency increased with age. Most children had systemic anomalies, but also other, usually multiple, ocular anomalies. The rate of postoperative complications was higher than among children with congenital cataracts, but without Down syndrome. In six cases, more than one complication/ case was identified. It was not possible to establish a clear correlation between the number and type of the postoperative complication and the systemic anomalies, nor was it possible to establish a correlation with the functional visual outcomes, because those children had other important ocular anomalies as well. Conclusions: Congenital cataracts with recommendations for surgical treatment in children suffering from Down syndrome have a low incidence, but an increase in frequency can be noticed with age. The recommended surgical technique is the one that involves maneuvers for the prevention of visual axis re-opacification. Per primam implantation is definitely indicated. The risk of postoperative complications is high, in terms of both frequency and number, with the possibility that more than one complication occurs, unrelated to a particular systemic anomaly, in one patient.
Collapse
|
21
|
Wang D, Li Z, Zhang F, Zhang Y, Zhao Y, Chang P, Fu Y, Zhao Y. Iridocorneal Angle and Anterior Segment Structure of Eyes in Children with Cataract. Ophthalmic Res 2019; 63:194-202. [PMID: 31770761 DOI: 10.1159/000505002] [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: 10/03/2019] [Accepted: 11/24/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the morphology of iridocorneal angle and anterior segment in eyes of children with cataract. METHODS In this prospective cross-sectional study, we included eyes of children with bilateral cataract as well as unilateral cataract and fellow eyes. The iridocorneal angle was evaluated using gonioscopy. We compared the preoperative structures of iridocorneal angle and anterior segment between cataractous eyes and fellow eyes. The grading of iridocorneal angle and anatomical changes were analyzed. RESULTS We finally recruited 55 eyes of 55 children with bilateral cataract and 41 cataractous eyes and 33 fellow eyes of 41 children with unilateral cataract. The fellow eyes were used as a control group. The iridocorneal angle was open in eyes with pediatric cataract when compared to control eyes. The eyes with cataract exhibited more pigments on the trabecular meshwork than control eyes did (unilateral cataract vs. control, p = 0.013; bilateral cataract vs. control, p = 0.002). The eyes with cataract exhibited a smaller cornea than control eyes (unilateral cataract vs. control, p = 0.031; bilateral cataract vs. control, p < 0.001). CONCLUSIONS The iridocorneal angle is open in the eyes of children with cataract. Eyes with increased pigments on the trabecular meshwork need to be carefully monitored and surgeons should to be on the alert for postoperative glaucoma.
Collapse
Affiliation(s)
- Dandan Wang
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, China
| | - Zhangliang Li
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, China
| | - Fan Zhang
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, China
| | - Yunjie Zhang
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, China
| | - Yuyu Zhao
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, China
| | - Pingjun Chang
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, China
| | - Yana Fu
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, China
| | - Yune Zhao
- School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, China, .,Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, China,
| |
Collapse
|
22
|
Incidence of and Risk Factors for Suspected Glaucoma and Glaucoma After Congenital and Infantile Cataract Surgery: A Longitudinal Study in China. J Glaucoma 2019; 29:46-52. [PMID: 31688374 DOI: 10.1097/ijg.0000000000001398] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRéCIS:: The overall incidence of postoperative suspected glaucoma and glaucoma after congenital cataract surgery is low; however, the identification of the associated risk factors helps to monitor susceptible individuals and to provide real-time surveillance and timely intervention. PURPOSE Pediatric patients who have undergone surgery for congenital or infantile cataracts have a risk of developing suspected glaucoma and glaucoma, but the current evidence does not address our understanding of the incidence and associated risk factors of suspected glaucoma/glaucoma for application in clinical standard care. Therefore, this study investigated the incidence of and risk factors for suspected glaucoma/glaucoma in patients who have undergone surgery for congenital/infantile cataracts. METHODS This study used a prospective cohort of 241 eyes from 241 patients who were 10 years of age or younger and who had undergone congenital/infantile cataract surgeries and were recruited from January 2011 to December 2016 at the Zhongshan Ophthalmic Center. Pediatric patients who underwent cataract surgery were classified into 2 groups according to intraocular lens (IOL) implantation. The patients' baseline characteristics and the incidence and risk factors for suspected glaucoma/glaucoma were assessed. RESULTS The incidence of suspected glaucoma after cataract surgery was 10.70% [26 of 241 eyes; 95% confidence interval (CI), 6.88%-14.70%]. The rate of suspected glaucoma developing into glaucoma was 26.92% (7 of 26 eyes; 95% CI, 9.87%-43.97%), and the incidence of glaucoma was 2.90% (7 of 241 eyes; 95% CI, 0.79%-5.03%). Our study revealed that the incidence of suspected glaucoma/glaucoma in patients who did not receive IOL implantation was 13.91% (21 of 151 eyes; 95% CI, 8.39%-19.42%), and the incidence in patients who received IOL implantation was 5.56% (5 of 90 eyes; 95% CI, 8.23%-10.28%). The preoperative central corneal thickness (hazard ratio, 1.003; 95% CI, 1.001 to 1.004; P=0.004) and a family history of congenital cataracts (hazard ratio, 2.314; 95% CI, 1.004-5.331; P=0.049) were significant risk factors in patients without IOL implantation. Patient age at the time of cataract surgery was not a statistically significant risk factor for the development of suspected glaucoma/glaucoma in patients without IOL implantation. CONCLUSIONS Identification of the incidence of and risk factors for suspected glaucoma/glaucoma may help clinicians monitor susceptible individuals and provide timely surveillance and interventions in a clinical setting. Age at the time of cataract surgery was not a risk factor for suspected glaucoma/glaucoma in patients without IOL implantation, and this may allow the timing window for pediatric cataract surgery to be expanded and support new insights into the optimal timing of surgery for standard care.
Collapse
|
23
|
Solebo AL, Rahi JS. Glaucoma following cataract surgery in the first 2 years of life: frequency, risk factors and outcomes from IoLunder2. Br J Ophthalmol 2019; 104:967-973. [DOI: 10.1136/bjophthalmol-2019-314804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/19/2019] [Accepted: 09/22/2019] [Indexed: 11/04/2022]
Abstract
BackgroundWe investigated glaucoma related adverse events, predictors and impact at 5 years following surgery in the IoLunder2 cohortMethodsPopulation based observational cohort study of children undergoing cataract surgery aged 2 years or under between January 2009 and December 2010. Glaucoma was defined using internationally accepted taxonomies based on the consequences of elevated intraocular pressure (IOP). Glaucoma related adverse events were any involving elevated IOP. Multivariable analysis was undertaken to investigate potential predictors of secondary glaucoma with adjustment for within-child correlation in bilateral cataract. Unilateral and bilateral cataract were analysed separately.ResultsComplete follow-up data were available for 235 of 254, 93% of the inception cohort. By 5 years after primary cataract surgery, 20% of children with bilateral cataract and 12% with unilateral had developed secondary glaucoma. Glaucoma related complications had been diagnosed in 24% and 36% of children, respectively. Independent predictors of glaucoma were younger age at surgery (adjusted OR for reduction of week in age: 1.1, 95%C I 1.1 to 1.2, p<0.001); the presence of significant ocular comorbidity (adj OR 3.2, 95% CI 1.1 to 9.6, p=0.01); and shorter axial length (adj OR for each mm 1.7, 95% CI 10.0 to 1, p=0.05) for bilateral cataract. Shorter axial length was the single independent factor in unilateral disease (adj OR 9.6, 95% CI 1.7 to 52, p=0.009)ConclusionsBoth younger age at surgery (the strongest marker of ocular ‘immaturity’) and smaller ocular size (a marker of both immaturity and developmental vulnerability) can be used to identify those at greatest risk of glaucoma due to early life cataract surgery.
Collapse
|
24
|
Murphy M, Murtagh P, McAnena L, Eldouri A, Kirwan C, O’Keefe M. Secondary glaucoma and visual axis opacification in aphakic and pseudophakic patients following congenital cataract surgery: A 28-year longitudinal case series. Eur J Ophthalmol 2019; 30:1370-1380. [DOI: 10.1177/1120672119862878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To determine the incidence, timing and risk factors for glaucoma and visual axis opacification development following surgery for congenital cataract in the first year of life. Methods: A prospective case series of all cataract surgery performed in Temple Street Children’s University Hospital over a 28-year period was conducted. A total of 93 subjects (135 eyes) were analysed. Sixty-two eyes had a primary intraocular lens inserted at the time of surgery; 73 eyes were aphakic. We recorded patient demographics, age at surgery, length of follow-up, rates and time to diagnosis of glaucoma and rates of visual axis opacification. Relative risk analysis was performed to identify potential risk factors for secondary glaucoma and visual axis opacification. Results: Mean length of follow-up was 160.02 ± 64.42 months (13.3 years), range 40–336 months. Final mean LogMAR across all groups was 0.85 ± 0.51 (0.90). Overall 45 (33.33%) eyes developed secondary glaucoma, 12 (19.4%) in pseudophakic eyes and 33 (45.21%) in aphakic eyes. The incidence of glaucoma was highest in bilateral aphakia (relative risk 1.96, p = 0.0240) and in eyes with corneal diameter <9.5 mm (relative risk 1.93, p = 0.0364). There was no significant difference in glaucoma rates between pseudophakia and aphakia in those operated on less than 2.5 months of age. Secondary glaucoma occurred between 3 months to 16.5 years post surgery. Rates of visual axis opacification were lower in aphakia compared to pseudophakia (relative risk 0.59, p = 0.0098). Conclusion: Overall glaucoma rates of one-third are similar to those recorded in the infantile aphakic treatment study. It can occur up to 17 years post cataract surgery, evidence that long-term follow-up is imperative.
Collapse
Affiliation(s)
- Melissa Murphy
- Temple Street Children’s University Hospital, Dublin, Ireland
| | - Patrick Murtagh
- Temple Street Children’s University Hospital, Dublin, Ireland
| | - Lisa McAnena
- Temple Street Children’s University Hospital, Dublin, Ireland
| | - Azher Eldouri
- Temple Street Children’s University Hospital, Dublin, Ireland
| | | | - Michael O’Keefe
- Temple Street Children’s University Hospital, Dublin, Ireland
| |
Collapse
|
25
|
Yagev R, Khatib N, Barrett C, Lior Y, Lifshitz T, Tsumi E. Intraocular lens implantation as an isolated risk factor for secondary glaucoma in pediatric patients. Can J Ophthalmol 2019; 54:621-625. [PMID: 31564355 DOI: 10.1016/j.jcjo.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/30/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the effect of intraocular lens (IOL) implantation on the development of secondary glaucoma after cataract surgery in pediatric patients. DESIGN Retrospective case series study. METHODS This study reviewed the medical records of children under 16 years of age who had undergone cataract surgery from 1996 to 2016 for congenital or developmental cataract. In every child an IOL was implanted in the primary surgery. Data collected included demographic information, age at cataract diagnosis and at surgery, surgical procedure, and postoperative follow-up of refraction, cup-to-disc ratio (C/D), intraocular pressure (IOP), and associated systemic and ocular anomalies. Patients with risk factors for glaucoma were excluded from the study. RESULTS Of the 255 children below age 16 years who underwent cataract extraction surgery with primary IOL implantation, 73 (124 eyes) met the inclusion criteria. Follow-up ranged from 4 to 18 years. Only 1 patient (0.8% of the 124 eyes) developed glaucoma in 1 of his 2 operated eyes; the surgeries were performed at 10 months, 1 week apart, and glaucoma was diagnosed 4 months later. One patient had suspected glaucoma in both eyes (incidence of 1.6%). Both these children were of Bedouin origin. CONCLUSION IOL implantation, by itself, is not a risk factor for development of secondary glaucoma after cataract surgery in a population below 16 years of age.
Collapse
Affiliation(s)
- Ronit Yagev
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Nur Khatib
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Chiya Barrett
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yotam Lior
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tova Lifshitz
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Erez Tsumi
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
26
|
Prospective analysis of the predictors of glaucoma following surgery for congenital and infantile cataract. Eye (Lond) 2018; 33:796-803. [PMID: 30560916 DOI: 10.1038/s41433-018-0316-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 10/08/2018] [Accepted: 12/02/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE A prospective longitudinal cohort study was performed to assess the incidence of and risk factors for the development of glaucoma following surgery for congenital/infantile cataract. METHODS One hundred and one eyes of one hundred and one children, ≤12 years of age who had follow-up of ≥24 months were included. Group I included those who underwent surgery using an anterior approach, group II included those who underwent surgery using a posterior approach, and group III included those who underwent surgery using an anterior approach along with foldable intraocular lens implantation. Standard definitions for glaucoma and glaucoma suspect were used. The Cox proportional hazard model was used to analyze risk factors for glaucoma. RESULTS Group I: 30 eyes (29.7%); group II: 11 eyes (10.9%); group III 60 eyes (59.4%). The incidence of glaucoma + glaucoma suspect was 7.9% (95% CL: 2.6, 13.2%) in the entire group. The incidence in group I was 16.7% (95% CL 3%, 30%), in group II was 18.2% (95% CL: 0, 41%) and in group III was 1.7% (95% CL: 0, 4.9%). Gonioscopy revealed high iris insertion with grade I (modified Shaffer grading) in one eye each in the glaucoma and glaucoma suspect group and open angles in the rest. Age at surgery of ≤3 months (HR: 6.6, 95% CL: 1.4, 30.6, p = 0.01) was found to be a significant risk factor within the aphakic group. CONCLUSIONS Younger age at the time of surgery was the only identifiable risk factor for glaucoma.
Collapse
|
27
|
Five-Year Postoperative Outcomes of Bilateral Aphakia and Pseudophakia in Children up to 2 Years of Age: A Randomized Clinical Trial. Am J Ophthalmol 2018; 193:33-44. [PMID: 29906430 DOI: 10.1016/j.ajo.2018.06.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Comparative evaluation of complications and visual outcomes following bilateral congenital cataract surgery in children up to 2 years of age with and without primary intraocular lens (IOL) implantation at 5 years follow-up. DESIGN Randomized controlled clinical trial. METHODS Sixty children (120 eyes) up to 2 years of age undergoing bilateral congenital cataract surgery were randomized to Group 1, primary aphakia (n = 30), or Group 2, primary IOL implantation (pseudophakia) (n = 30). A single surgeon performed surgeries with identical surgical technique. All patients were followed up regularly until 5 years postoperatively. At each follow-up, glaucoma, visual axis obscuration (VAO) requiring surgery, and inflammation (cell deposits, posterior synechiae) were assessed. Visual acuity was assessed until 5 years follow-up. The first operated eye was selected for statistical analysis. RESULTS Median age of the patients at time of surgery was 5.11 months (aphakia group) and 6.01 months (pseudophakia group) (P = .56). Five years postoperatively, incidence of glaucoma was 16% and 13.8% in Groups 1 and 2 (P = .82). Incidence of posterior synechiae was significantly higher in the pseudophakia group (27.6%) compared to the aphakia group (8%) (P = .004). VAO requiring surgery was seen in 8% and 10.3% of eyes in Groups 1 and 2 (P = .76). Mean logMAR visual acuity at 5 years follow-up was 0.59 ± 0.33 and 0.5 ± 0.23 in Groups 1 and 2, respectively (P = .79). However, more eyes in the pseudophakic group started giving documentable vision earlier in their postoperative follow-ups. CONCLUSIONS Incidence of postoperative complications was comparable between the groups, except for a higher incidence of posterior synechiae in pseudophakic eyes. Visual rehabilitation was faster in the pseudophakic group.
Collapse
|
28
|
Xie YB, Ren MY, Wang Q, Wang LH. Intraocular lens optic capture in pediatric cataract surgery. Int J Ophthalmol 2018; 11:1403-1410. [PMID: 30140648 DOI: 10.18240/ijo.2018.08.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/27/2018] [Indexed: 12/28/2022] Open
Abstract
Posterior capsule opacification (PCO) remains the most common complication of pediatric cataract surgery despite continuous efforts to reduce its incidence. For this reason, pediatric cataract surgeons have expended considerable effort into preventing and mitigating PCO. The intraocular lens (IOL) optic capture technique has been used for the prevention of PCO after pediatric cataract surgery for more than 20y, but there is still no professional consensus. However, recent research has shown encouraging results. The IOL optic capture technique can be performed without anterior vitrectomy to prevent PCO, even in younger children. The type and characteristics of IOLs used for optic capture technique, the location of IOL and the complications of IOL optic capture in children are here reviewed.
Collapse
Affiliation(s)
- Ying-Bin Xie
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Mei-Yu Ren
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Qi Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Li-Hua Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| |
Collapse
|
29
|
Lee GI, Han JC, Kim SB, Lee EJ, Kee CW. Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.6.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ga-In Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Si Bum Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Won Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
30
|
I Gawdat G, M Youssef M, M Bahgat N, M Elfayoumi D, As Eddin M. Incidence and Risk Factors of Early-onset Glaucoma following Pediatric Cataract Surgery in Egyptian Children: One-year Study. J Curr Glaucoma Pract 2017; 11:80-85. [PMID: 29151681 PMCID: PMC5684237 DOI: 10.5005/jp-journals-10028-1229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022] Open
Abstract
Aim To study the incidence and risk factors of glaucoma occurring within 1 year following pediatric cataract surgery in Egyptian children. Materials and methods This is a prospective nonrandomized study conducted at Aburich Children’s Hospital, over a period of 1 year on a cohort of Egyptian patients with congenital and infantile cataract. One hundred and fifty eyes of 88 patients were enrolled in this study. All the patients underwent anterior approach removal of lens matter, whereas primary intraocular lens (IOL) implantation was carried at the age of 1 and 2 years for unilateral and bilateral cases respectively. Intraocular pressure (IOP) was measured at 1 week, 1 month, 3 months, 6 months, 9 months, and 1 year. For those who developed glaucoma, time of diagnosis and associated risk factors were reported. Results The incidence of glaucoma was 11.33% (17 of 150 eyes), while incidence of glaucoma suspect was 0.67% (1 of 150 eyes) in the first year following cataract surgery. The majority of the cases (66.7%) were discovered in the first 3 months postcataract surgery. Age at time of cataract surgery, the state of aphakia/pseudophakia, persistent fetal vasculature (PFV), and microphthalmia were not found to be significant predictors of early-onset glaucoma in our study. Conclusion Aphakic glaucoma continues to be a devastating condition with high incidence during first year following cataract surgery. Clinical significance Regular follow-up should start as early as possible following cataract surgery. Further prospective studies with larger study population are required. How to cite this article: Gawdat GI, Youssef MM, Bahgat NM, Elfayoumi DM, Eddin MAS. Incidence and Risk Factors of Early-onset Glaucoma following Pediatric Cataract Surgery in Egyptian Children: One-year Study. J Curr Glaucoma Pract 2017;11(3):80-85.
Collapse
Affiliation(s)
- Ghada I Gawdat
- Professor, Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Maha M Youssef
- Lecturer, Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Nermeen M Bahgat
- Lecturer, Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Dina M Elfayoumi
- Assistant Professor, Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohamed As Eddin
- Assistant Professor, Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt
| |
Collapse
|
31
|
Ezegwui I, Ravindran M, Pawar N, Allapitchai F, Rengappa R, Raman RR. Glaucoma following childhood cataract surgery: the South India experience. Int Ophthalmol 2017; 38:2321-2325. [PMID: 29038958 DOI: 10.1007/s10792-017-0728-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the characteristics and risk factors for the development of glaucoma after cataract surgery in children seen at a major referral tertiary eye centre in South India. METHODS This is a retrospective review of the medical records of consecutive patients seen at the glaucoma/paediatric eye clinic of the centre, with a diagnosis of glaucoma secondary to aphakia/pseudophakia over a 5-year period. RESULTS There were 21 eyes of 14 children that developed glaucoma and 23 eyes of 12 children were selected as control. The mean age (standard deviation SD) at the time of cataract surgery for the glaucoma group was 7.4 (± 10.1) months and 39.13 (± 41.2) months for the control. The mean follow-up (SD) period was 114.29 (± 61.9) months and 97.61 (± 43.5) months for the glaucoma and control, respectively. The mean duration from cataract surgery to onset of glaucoma was 81.19 (± 52.4) months (median 66 months, range 21-172 months). Multivariate analysis detected age at surgery younger than 12 months (OR 10.45, 95%CI 1.76-62.03, p = 0.010) and ocular anomalies mainly microcornea (OR 7.11, 95%CI 1.14-44.46, p = 0.036) as risk factors for development of glaucoma after paediatric cataract surgery. CONCLUSION Glaucoma can develop several years after childhood cataract surgery. Surgery in the first year of life and microcornea are risk factors for the development of glaucoma post-surgery. Signs of glaucoma should specifically be looked for during follow-up visits.
Collapse
Affiliation(s)
- Ifeoma Ezegwui
- Paediatric Ophthalmology and Adult Strabismus Services, Aravind Eye Hospital, Tirunelveli, India. .,Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
| | - Meenakshi Ravindran
- Paediatric Ophthalmology and Adult Strabismus Services, Aravind Eye Hospital, Tirunelveli, India
| | - Neelam Pawar
- Paediatric Ophthalmology and Adult Strabismus Services, Aravind Eye Hospital, Tirunelveli, India
| | - Fathima Allapitchai
- Paediatric Ophthalmology and Adult Strabismus Services, Aravind Eye Hospital, Tirunelveli, India
| | | | | |
Collapse
|
32
|
European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 2: Classification and terminologySupported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 2 Classification and Terminology. Br J Ophthalmol 2017; 101:73-127. [PMID: 28424171 PMCID: PMC5583685 DOI: 10.1136/bjophthalmol-2016-egsguideline.002] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
33
|
The long-term anterior segment configuration after pediatric cataract surgery and the association with secondary glaucoma. Sci Rep 2017; 7:43015. [PMID: 28220849 PMCID: PMC5318954 DOI: 10.1038/srep43015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/18/2017] [Indexed: 11/09/2022] Open
Abstract
Secondary glaucoma constitutes major sight-threatening complication of pediatric cataract surgery, yet the etiology remains unclear. The purpose of this study was to investigate the long-term anterior segment configuration and the association with secondary glaucoma in pediatric pseudophakia. Ultrasound biomicroscopy (UBM) was performed on 40 eyes of 26 children underwent pediatric cataract surgery and intraocular lens (IOL) implantation. The anterior chamber depth (ACD), angle-opening distance at 500 μm (AOD500), trabecular-iris angle (TIA), central corneal thickness (CCT), structural abnormities, IOL position, IOP, and incidence of glaucoma were evaluated. High insertion of iris, in which the iris root is attached more anteriorly than normal, was seen in 13 eyes (32.50%). IOL was located in the capsular bag in 19 eyes and in the ciliary sulcus in 21 eyes. Logistic regression analysis identified high insertion of iris (OR 3.40, 95% CI 1.03-11.17, p = 0.03) and IOL implantation in sulcus (OR 1.39, 95% CI 1.07-4.85, p = 0.04) as independent risk factors for glaucoma. The presence of high insertion of iris and IOL implantation in ciliary sulcus may increase the long-term risk of the development of secondary glaucoma after pediatric cataract surgery.
Collapse
|
34
|
Vasavada AR, Vasavada V. Current Status of IOL implantation in pediatric eyes: an update. Expert Rev Med Devices 2017; 14:1-9. [PMID: 28042714 DOI: 10.1080/17434440.2016.1271706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/09/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Pediatric cataracts are a huge problem worldwide, and with improving techniques and technology, the surgical treatment and postoperative visual rehabilitation are improving. Despite intraocular lenses(IOLs) being the standard of care for adult cataract surgery, this issue is still somewhat controversial, particularly in young children and infants due to lack of unequivocal evidence. This review therefore summarises the findings from recent studies on the aspect of IOL implantation in pediatric eyes. Areas covered: An extensive literature search was undertaken for published articles on congenital/developmental pediatric cataracts, and IOL implantation, where literature pertinent to traumatic and subluxated cataracts was not included in the review. Pubmed was used for literature search, and keywords entered were : pediatric, cataract surgery, intraocular lens, persistent fetal vasculature, outcomes, complications, visual performance with intraocular lenses. Expert commentary: Recent literature supports IOL implantation in most cases of congenital / developmental pediatric cataracts, and it seems like the way forward. However, the jury is still out on IOL implantation in infants, particularly in bilateral cataracts. Thus, surgeons must be extremely cautious in planning primary IOL implantation in infant eyes, and if they do perform IOL implantation, rigorous followup is mandatory.
Collapse
Affiliation(s)
- Abhay R Vasavada
- a Iladevi Cataract & IOL Research Centre, Raghudeep Eye Hospital , Ahmedabad , India
| | - Vaishali Vasavada
- a Iladevi Cataract & IOL Research Centre, Raghudeep Eye Hospital , Ahmedabad , India
| |
Collapse
|
35
|
Ma AS, Grigg JR, Ho G, Prokudin I, Farnsworth E, Holman K, Cheng A, Billson FA, Martin F, Fraser C, Mowat D, Smith J, Christodoulou J, Flaherty M, Bennetts B, Jamieson RV. Sporadic and Familial Congenital Cataracts: Mutational Spectrum and New Diagnoses Using Next-Generation Sequencing. Hum Mutat 2016; 37:371-84. [PMID: 26694549 PMCID: PMC4787201 DOI: 10.1002/humu.22948] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/14/2015] [Indexed: 12/13/2022]
Abstract
Congenital cataracts are a significant cause of lifelong visual loss. They may be isolated or associated with microcornea, microphthalmia, anterior segment dysgenesis (ASD) and glaucoma, and there can be syndromic associations. Genetic diagnosis is challenging due to marked genetic heterogeneity. In this study, next-generation sequencing (NGS) of 32 cataract-associated genes was undertaken in 46 apparently nonsyndromic congenital cataract probands, around half sporadic and half familial cases. We identified pathogenic variants in 70% of cases, and over 68% of these were novel. In almost two-thirds (20/33) of these cases, this resulted in new information about the diagnosis and/or inheritance pattern. This included identification of: new syndromic diagnoses due to NHS or BCOR mutations; complex ocular phenotypes due to PAX6 mutations; de novo autosomal-dominant or X-linked mutations in sporadic cases; and mutations in two separate cataract genes in one family. Variants were found in the crystallin and gap junction genes, including the first report of severe microphthalmia and sclerocornea associated with a novel GJA8 mutation. Mutations were also found in rarely reported genes including MAF, VIM, MIP, and BFSP1. Targeted NGS in presumed nonsyndromic congenital cataract patients provided significant diagnostic information in both familial and sporadic cases.
Collapse
Affiliation(s)
- Alan S. Ma
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of Clinical GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - John R. Grigg
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Gladys Ho
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Ivan Prokudin
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Elizabeth Farnsworth
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Katherine Holman
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Anson Cheng
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Frank A. Billson
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Frank Martin
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Clare Fraser
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - David Mowat
- Department of Medical GeneticsSydney Children's HospitalSydneyNew South WalesAustralia
| | - James Smith
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - John Christodoulou
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Maree Flaherty
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Bruce Bennetts
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Robyn V. Jamieson
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of Clinical GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| |
Collapse
|
36
|
Freedman SF, Lynn MJ, Beck AD, Bothun ED, Örge FH, Lambert SR. Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study. JAMA Ophthalmol 2015; 133:907-14. [PMID: 25996491 DOI: 10.1001/jamaophthalmol.2015.1329] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Glaucoma-related adverse events constitute major sight-threatening complications of cataract removal in infancy, yet their relationship to aphakia vs primary intraocular lens (IOL) implantation remains unsettled. OBJECTIVE To identify and characterize cases of glaucoma and glaucoma-related adverse events (glaucoma + glaucoma suspect) among children in the Infant Aphakia Treatment Study by the age of 5 years. DESIGN, SETTING, AND PARTICIPANTS A multicenter randomized clinical trial of 114 infants with unilateral congenital cataract in referral centers who were between ages 1 and 6 months at surgery. Mean follow-up was 4.8 years. This secondary analysis was conducted from December 23, 2004, to November 13, 2013. INTERVENTIONS Participants were randomized at cataract surgery to either primary IOL or no IOL implantation (contact lens). Standardized definitions of glaucoma and glaucoma suspect were created for the Infant Aphakia Treatment Study and applied for surveillance and diagnosis. MAIN OUTCOMES AND MEASURES Development of glaucoma and glaucoma + glaucoma suspect in operated on eyes for children up to age 5 years, plus intraocular pressure, visual acuity, and axial length at age 5 years. RESULTS Product limit estimates of the risk for glaucoma and glaucoma + glaucoma suspect at 4.8 years after surgery were 17% (95% CI, 11%-25%) and 31% (95% CI, 24%-41%), respectively. The contact lens and IOL groups were not significantly different for either outcome: glaucoma (hazard ratio [HR], 0.8; 95% CI, 0.3-2.0; P = .62) and glaucoma + glaucoma suspect (HR, 1.3; 95% CI, 0.6-2.5; P = .58). Younger (vs older) age at surgery conferred an increased risk for glaucoma (26% vs 9%, respectively) at 4.8 years after surgery (HR, 3.2; 95% CI, 1.2-8.3), and smaller (vs larger) corneal diameter showed an increased risk for glaucoma + glaucoma suspect (HR, 2.5; 95% CI, 1.3-5.0). Age and corneal diameter were significantly positively correlated. Glaucoma was predominantly open angle (19 of 20 cases, 95%), most eyes received medication (19 of 20, 95%), and 8 of 20 eyes (40%) underwent surgery. CONCLUSIONS AND RELEVANCE These results suggest that glaucoma-related adverse events are common and increase between ages 1 and 5 years in infants after unilateral cataract removal at 1 to 6 months of age; primary IOL placement does not mitigate their risk but surgery at a younger age increases the risk. Longer follow-up of these children may further characterize risk factors, long-term outcomes, potential differences between eyes having primary IOL vs aphakia, and optimal timing of unilateral congenital cataract removal. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212134.
Collapse
Affiliation(s)
- Sharon F Freedman
- Duke Eye Center, Duke University Medical Center, Durham, North Carolina
| | - Michael J Lynn
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Allen D Beck
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Erick D Bothun
- Department of Ophthalmology, University of Minnesota, Minneapolis5Department of Neurovisual Sciences, University of Minnesota, Minneapolis6Department of Pediatrics, University of Minnesota, Minneapolis
| | - Faruk H Örge
- Department of Ophthalmology, Case Medical Center University Hospitals, Cleveland, Ohio
| | - Scott R Lambert
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | |
Collapse
|
37
|
Abdolrahimzadeh S, Fameli V, Mollo R, Contestabile MT, Perdicchi A, Recupero SM. Rare Diseases Leading to Childhood Glaucoma: Epidemiology, Pathophysiogenesis, and Management. BIOMED RESEARCH INTERNATIONAL 2015; 2015:781294. [PMID: 26451378 PMCID: PMC4588342 DOI: 10.1155/2015/781294] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/22/2015] [Indexed: 11/17/2022]
Abstract
Noteworthy heterogeneity exists in the rare diseases associated with childhood glaucoma. Primary congenital glaucoma is mostly sporadic; however, 10% to 40% of cases are familial. CYP1B1 gene mutations seem to account for 87% of familial cases and 27% of sporadic cases. Childhood glaucoma is classified in primary and secondary congenital glaucoma, further divided as glaucoma arising in dysgenesis associated with neural crest anomalies, phakomatoses, metabolic disorders, mitotic diseases, congenital disorders, and acquired conditions. Neural crest alterations lead to the wide spectrum of iridocorneal trabeculodysgenesis. Systemic diseases associated with childhood glaucoma include the heterogenous group of phakomatoses where glaucoma is frequently encountered in the Sturge-Weber syndrome and its variants, in phakomatosis pigmentovascularis associated with oculodermal melanocytosis, and more rarely in neurofibromatosis type 1. Childhood glaucoma is also described in systemic disorders of mitotic and metabolic activity. Acquired secondary glaucoma has been associated with uveitis, trauma, drugs, and neoplastic diseases. A database research revealed reports of childhood glaucoma in rare diseases, which do not include glaucoma in their manifestation. These are otopalatodigital syndrome, complete androgen insensitivity, pseudotrisomy 13, Brachmann-de Lange syndrome, acrofrontofacionasal dysostosis, caudal regression syndrome, and Wolf-Hirschhorn syndrome.
Collapse
Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, DAI Head/Neck, Umberto I Policlinic, University of Rome “Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Valeria Fameli
- Ophthalmology Unit, Department of Sense Organs, University of Rome “Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Roberto Mollo
- Ophthalmology Unit, DAI Head/Neck, Umberto I Policlinic, University of Rome “Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Teresa Contestabile
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome “Sapienza”, via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Andrea Perdicchi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome “Sapienza”, via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Santi Maria Recupero
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome “Sapienza”, via di Grottarossa 1035-1039, 00189 Rome, Italy
| |
Collapse
|
38
|
Johnson WJ, Wilson ME, Trivedi RH. Pediatric cataract surgery: challenges. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1086644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
39
|
Bayoumi NHL. Surgical Management of Glaucoma After Congenital Cataract Surgery. J Pediatr Ophthalmol Strabismus 2015; 52:213-20. [PMID: 25915009 DOI: 10.3928/01913913-20150414-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/15/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Cataract surgery in children is a difficult entity with possible complications, glaucoma being particularly common. The purpose of this study was to explore the results of surgical intervention for glaucoma after congenital cataract surgery in Alexandria University, Egypt. METHODS The study was a retrospective chart review of 32 children with glaucoma after congenital cataract surgery between 2005 and 2012. Preoperative, operative, and postoperative data were collected. Complications were noted. Success was studied at the end of follow-up. RESULTS The study included 41 (36 aphakic, 5 pseudophakic) eyes of 32 children undergoing 57 glaucoma surgical procedures. The mean ± standard deviation age at the time of surgery was 17.2 ± 21.6 months (range: 3.0 to 103.5 months) and the mean follow-up period was 39.1 ± 25.2 months (range: 1 to 75 months). The most common (78%) primary glaucoma surgical procedure was combined trabeculotomy-trabeculectomy with mitomycin C. The mean preoperative intraocular pressure, corneal diameter and thickness, cup-disc ratio, and axial length of the study eyes was 22.3 ± 6.1 mm Hg (range: 10 to 34 mm Hg), 11.4 ± 0.9 mm (range: 10 to 13 mm) and 617.6 ± 66.8 µm (range: 538 to 758 µm), 0.5 ± 0.3 mm (range: 0 to 1 mm), and 22.85 ± 2.75 mm (range: 18.55 to 29.17 mm), respectively, and postoperatively at last follow-up was 11.0 ± 7.3 mm Hg (range: 1 to 36 mm Hg), 11.5 ± 0.9 mm (range: 10 to 13 mm) and 576.8 ± 83.3 µm (range: 461 to 736 µm), 0.4 ± 0.3 mm (range: 0 to 1 mm), and 24.62 ± 2.81 mm (range: 19.70 to 32.81 mm), respectively. Success was reported in 34 (82.9%) eyes. Complications included endophthalmitis, hypotony disc edema, and retinal detachment. CONCLUSIONS Glaucoma after congenital cataract surgery is a difficult entity, often requiring more than one surgical procedure to control it. Long-term follow-up is mandatory to detect any failure of treatment at any time point and manage accordingly.
Collapse
|
40
|
Yusuf IH, Patel CK, Salmon JF. Unilateral persistent hyperplastic primary vitreous: intensive management approach with excellent outcome beyond visual maturation. BMJ Case Rep 2015; 2015:bcr-2014-206525. [PMID: 25564632 DOI: 10.1136/bcr-2014-206525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Persistent hyperplastic primary vitreous (PHPV) is an ocular developmental disorder resulting from incomplete apoptosis of the embryonic hyaloid vasculature. Unilateral PHPV is traditionally associated with a poor prognosis because of the challenges associated with managing progressive anisometropic amblyopia. We report a child with unilateral PHPV who underwent cataract extraction, primary posterior capsulotomy with anterior vitrectomy and intraocular lens implantation followed by combined trabeculectomy/trabeculotomy within the first 8 weeks of life. Intensive optometric and orthoptic input was required for many years to manage the increasing anisometropic amblyopia with final visual acuity of 20/40 unaided in the affected eye and without evidence of glaucomatous optic neuropathy. This case illustrates the excellent visual outcome possible in a child with complex, unilateral PHPV using an intensive management approach comprising: early surgical intervention for congenital cataract and secondary glaucoma, meticulous monitoring of refraction, visual acuity and intraocular pressure and motivated parents who engaged in the management.
Collapse
|
41
|
Matsuo T. Intraocular lens implantation in unilateral congenital cataract with minimal levels of persistent fetal vasculature in the first 18 months of life. SPRINGERPLUS 2014; 3:361. [PMID: 25061553 PMCID: PMC4108679 DOI: 10.1186/2193-1801-3-361] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 11/25/2022]
Abstract
Purpose To describe the incidence of unilateral congenital cataract associated with minimal (ultrasonically undetectable) levels of persistent fetal vasculature in the first 18 months of the life and to report surgical methods for intraocular lens implantation, using 25-gauge vitrectomy system. Methods Retrospective review was made on 16 consecutive patients with bilateral or unilateral congenital cataract in the first 18 months of the life who underwent surgery at Okayama University Hospital after the introduction of the 25-gauge vitrectomy system from October 2005 to March 2013. As the standard of care at this hospital in the study period, intraocular lenses were not implanted in children with bilateral cataract while intraocular lenses were implanted in those with unilateral cataract. Results Ten children with bilateral cataract underwent lensectomy in both eyes with a 25-gauge vitreous cutter under irrigation with a 25-gauge infusion cannula, inserted from two side ports at the corneal limbus. Six children with unilateral cataract underwent intraocular lens implantation and posterior capsulotomy after lens aspiration from limbal side ports. No patient showed vitreous abnormalities on ultrasound examinations before the surgery. At the surgery, all 10 children with bilateral cataract showed no additional abnormalities. In contrast, 3 children with unilateral cataract at the age younger than 12 months showed white fibrous tissue in the anterior vitreous integrated with the posterior lens capsule while the other 3 children with unilateral cataract at the age from 12 to 18 months did not have vitreous abnormalities. The fibrous tissue was cut together in the process of posterior capsulotomy from a 25-gauge trocar inserted at 1.5 mm posterior from the corneal limbus. Conclusions Unilateral congenital cataract in the first 12 months of the life has a high incidence for the association with anterior type of persistent fetal vasculature which could not be detected by preoperative ultrasound examinations. Intraocular lens implantation was technically feasible in unilateral cataract with or without minimal levels of persistent fetal vasculature in the first 18 months of the life.
Collapse
Affiliation(s)
- Toshihiko Matsuo
- Department of Ophthalmology, Okayama University Medical School and Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Okayama City, 700-8558 Japan
| |
Collapse
|
42
|
Gogate PM, Sahasrabudhe M, Shah M, Patil S, Kulkarni AN, Trivedi R, Bhasa D, Tamboli R, Mane R. Long term outcomes of bilateral congenital and developmental cataracts operated in Maharashtra, India. Miraj pediatric cataract study III. Indian J Ophthalmol 2014; 62:186-95. [PMID: 24618489 PMCID: PMC4005236 DOI: 10.4103/0301-4738.128630] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 03/15/2013] [Indexed: 11/05/2022] Open
Abstract
AIM To study long term outcome of bilateral congenital and developmental cataract surgery. SUBJECTS 258 pediatric cataract operated eyes of 129 children. MATERIALS AND METHODS Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF) were noted for before and after surgery. STATISTICS Statistical analysis was done with SPSS version 16 including multi-variate analysis. RESULTS Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years) at the time of surgery. 74/129 (57.4%) were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years). 177 (68.6%) eyes had vision <3/60 before surgery, while 109 (42.2%) had best corrected visual acuity (BCVA) >6/18 and 157 (60.9%) had BCVA >6/60 3-8 years after surgery. 48 (37.2%) had binocular stereoacuity <480 sec of arc by TNO test. Visual outcome depended on type of cataract (P = 0.004), type of cataract surgery (P < 0.001), type of intra-ocular lens (P = 0.05), age at surgery (P = 0.004), absence of post-operative uveitis (P = 0.01) and pre-operative vision (P < 0.001), but did not depend on delay (0.612) between diagnosis and surgery. There was a statistically significant improvement for all the 20 questions of the LVP-CVF scale (P < 0.001). CONCLUSION Pediatric cataract surgery improved the children's visual acuity, stereo acuity and vision function. Developmental cataract, use of phacoemulsification, older children and those with better pre-operative vision had betterlong-termoutcomes.
Collapse
Affiliation(s)
- Parikshit M Gogate
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
- Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
- D.Y.Patil Medical College, Pimpri, Pune, Maharashtra, India
| | | | - Mitali Shah
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
| | - Shailbala Patil
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
| | - Anil N Kulkarni
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
- Dr. Kulkarni Eye Hospital, Miraj, District Sangli, Maharashtra, India
- Department of Ophthalmology, BhartiVidyapeeth Medical College, Vishrambaug, Sangli, Maharashtra, India
| | | | - Divya Bhasa
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
| | - Rahin Tamboli
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
| | - Rekha Mane
- Lions NAB Eye Hospital, Miraj, District Sangli, Maharashtra, India
| |
Collapse
|
43
|
Lambert SR, Purohit A, Superak HM, Lynn MJ, Beck AD. Long-term risk of glaucoma after congenital cataract surgery. Am J Ophthalmol 2013; 156:355-361.e2. [PMID: 23639132 PMCID: PMC3720778 DOI: 10.1016/j.ajo.2013.03.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/11/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the long-term risk of glaucoma development in children following congenital cataract surgery. DESIGN Retrospective interventional consecutive case series. METHODS We retrospectively reviewed the records of 62 eyes of 37 children who underwent congenital cataract surgery when <7 months of age by the same surgeon using a limbal approach. The Kaplan-Meier method was used to calculate the probability of an eye's developing glaucoma and/or becoming a glaucoma suspect over time. RESULTS The median age of surgery was 2.0 months and the median follow-up after cataract surgery was 7.9 years (range, 3.2-23.5 years). Nine eyes (14.5%) developed glaucoma a median of 4.3 months after cataract surgery and an additional 16 eyes (25.8%) were diagnosed as glaucoma suspects a median of 8.0 years after cataract surgery. The probability of an eye's developing glaucoma was estimated to be 19.5% (95% CI: 10.0%-36.1%) by 10 years after congenital cataract surgery. When the probability of glaucoma and glaucoma suspect were combined, the risk increased to 63.0% (95% CI: 43.6%-82.3%). CONCLUSIONS Long-term monitoring of eyes after congenital cataract surgery is important because we estimate that nearly two thirds of these eyes will develop glaucoma or become glaucoma suspects by 10 years after cataract surgery.
Collapse
Affiliation(s)
- Scott R Lambert
- Department of Ophthalmology, Emory University, Atlanta, GA 30322, USA.
| | | | | | | | | |
Collapse
|
44
|
Sahin A, Caça I, Cingü AK, Türkcü FM, Yüksel H, Sahin M, Cinar Y, Ari S. Secondary glaucoma after pediatric cataract surgery. Int J Ophthalmol 2013; 6:216-20. [PMID: 23638427 DOI: 10.3980/j.issn.2222-3959.2013.02.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 03/05/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To determine the incidence and risk factors of secondary glaucoma after pediatric cataract surgery. METHODS Two hundred and forty nine eyes of 148 patients underwent cataract surgery without intraocular lens (IOL) implantation (group 1), and 220 eyes of 129 patients underwent cataract surgery with IOL implantation (group 2) retrospectively, were evaluated between 2000 and 2011. The outcome measure was the presence or absence of post-cataract surgery glaucoma, defined as an intraocular pressure (IOP) ≥26mmHg, as measured on at least two occasions along with corneal or optic nerve changes. RESULTS The mean follow-up periods of group 1 and 2 were (60.86±30.95) months (12-123 months) and (62.11±31.29) months (14-115 months) respectively. In group 1, 12 eyes of 8 patients (4.8%) developed glaucoma. None of the patients developed glaucoma after surgery in group 2. The mean age of the patients at the cataract surgery was (2.58±0.90) months (1 month-4 months) and the average period for glaucoma development after surgery was (9.50±4.33) months (4-16 months) in group 1. Three of the 12 glaucomatous eyes were controlled with antiglaucomatous medication and 9 eyes underwent trabeculectomy+mitomycin C surgery. One patient underwent a second trabeculectomy + mitomycin C operation for both of his eyes. CONCLUSION The incidence of glaucoma after pediatric cataract surgery is very low in patients in whom IOL is implanted. The aphakic eyes after pediatric cataract surgery are at an increased risk for glaucoma development particularly if they underwent surgery before 4 months of age.
Collapse
Affiliation(s)
- Alparslan Sahin
- Department of Ophthalmology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Baden C, Shija F, Lewallen S, Courtright P, Hall A. Glaucoma after pediatric cataract surgery in a population with limited access to care. J AAPOS 2013; 17:158-62. [PMID: 23528376 DOI: 10.1016/j.jaapos.2012.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cataract is a leading cause of childhood blindness in eastern Africa and other resource-constrained regions around the world, and high-quality surgical centers are increasingly responding to this challenge. Despite evidence concerning the ongoing risk of postoperative glaucoma after lensectomy, little is known of the incidence of glaucoma after pediatric cataract surgery in Africa. We sought to evaluate the frequency and predictors of postoperative glaucoma in this setting. METHODS The medical records of all children who underwent surgery for congenital or developmental cataract between 2003 and 2005 at the Kilimanjaro Christian Medical Centre were retrospectively reviewed to determine the incidence of postoperative glaucoma. Potential risk factors were evaluated by means of logistic regression. RESULTS Cumulative incidence of glaucoma at 3 years was 6.5% (95% CI, 2.5-16.0), and the annual incidence rate was 2.0 cases per 100 operated eyes (95% confidence interval, 0.74-4.37). Total time of follow-up and absence of primary intraocular lens implantation correlated with risk for postoperative glaucoma, but multivariate analysis could not confirm independent associations. CONCLUSIONS As cataract surgical rates continue to increase and pediatric ophthalmology centers in Africa progress toward the goals of Vision 2020: The Right to Sight, renewed efforts must be directed toward the long-term postoperative care of all children undergoing operation for pediatric cataract.
Collapse
Affiliation(s)
- Craig Baden
- University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
| | | | | | | | | |
Collapse
|
46
|
Ruddle JB, Staffieri SE, Crowston JG, Sherwin JC, Mackey DA. Incidence and predictors of glaucoma following surgery for congenital cataract in the first year of life in Victoria, Australia. Clin Exp Ophthalmol 2013; 41:653-61. [PMID: 23332011 DOI: 10.1111/ceo.12067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Abstract
AIM To determine the incidence and predictors of glaucoma following surgery for congenital and infantile cataract in an Australian population. DESIGN Retrospective cohort study. PARTICIPANTS Infants (<12 months) having had lens extraction between January 1992 and May 2006, from two tertiary referral centres. METHODS Children with uveitis, anterior segment dysgenesis, aniridia, retinopathy of prematurity, and lens subluxation were excluded. Potential predictors of incident glaucoma were examined using Cox proportional hazards regression with adjustment for clustering between eyes. MAIN OUTCOME MEASURES Incidence and predictors of secondary glaucoma. RESULTS One hundred and forty-seven eyes of 101 patients (46 bilateral cataract; 55 unilateral cataract) were included, with median follow-up of 9.9 years (range 1.2-18.9 years). Cumulative incidence of glaucoma was 32.0% for eyes (n = 47) and 30.7% (n = 31) for subjects. Incidence was higher in children with bilateral cataract (38.9 vs. 17.1%, p = 0.004). There were 3.9 cases of glaucoma per 100 person years of follow-up, the incidence rate being highest for surgery performed in the first month of life. Children with glaucoma had longer median follow-up (11.8 vs. 9.3 years, p = 0.005). Risk of glaucoma decreased with increasing months of age at operation: hazard ratio 0.79, 95% confidence interval 0.69-0.91, p = 0.001. Median visual acuity was worse in children with unilateral cataract (p < 0.001). CONCLUSIONS We identified an increased risk of glaucoma when cataract surgery was performed in younger infants, and in those with bilateral cataract. As glaucoma may develop over a decade following lens extraction, life-long surveillance is needed to prevent glaucoma-associated vision loss.
Collapse
Affiliation(s)
- Jonathan B Ruddle
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | | | | | | | | |
Collapse
|
47
|
Intraocular pressure elevation is a delayed-onset complication after successful vitrectomy for stages 4 and 5 retinopathy of prematurity. Retina 2012; 32:1636-42. [PMID: 22575901 DOI: 10.1097/iae.0b013e3182551c54] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the incidence and risk factors for delayed-onset intraocular pressure (IOP) elevations after vitrectomy for Stages 4 and 5 retinopathy of prematurity and, in addition, to determine the results of treating the IOP elevations. METHODS Fifty-five consecutive eyes with successful retinal reattachment and at least 24 months of follow-up after vitrectomy were studied. The ophthalmic examinations included slit-lamp biomicroscopy, wide-field digital retinal imaging, and IOP measurements. Eyes were classified into 2 groups: eyes with a postoperative IOP elevation to ≥ 21 mmHg and eyes whose IOP was always <21 mmHg. RESULTS Eight eyes (14.5%) developed an IOP elevation to ≥ 21 mmHg from 2 months to 4 months (median: 2.5 months) after the vitrectomy. In two of these eyes, the IOP was controlled with antiglaucoma medications. In the other six eyes, trabeculotomy for eyes with open angles and trabeculectomy or goniosynechialysis for eyes with closed angles were performed. The IOPs were successfully controlled after an average of 1.5 glaucoma surgeries. Multivariate logistic regression analyses identified that a young gestational age (odds ratio = 1.147, 95% confidence interval: 1.024-1.346) and lensectomy (odds ratio = 8.795, 95% confidence interval: 1.262-183.3) were significantly associated with the IOP elevation. CONCLUSION Delayed-onset IOP elevation after vitrectomy for retinopathy of prematurity occurs in 14.5% of the eyes, and it is significantly associated with a young gestational age and presence of lensectomy.
Collapse
|
48
|
Abstract
Modern surgical techniques allow congenital cataract surgery to be performed much more successfully. The development of a secondary glaucoma is the most dreaded postoperative complication (one third of all pediatric secondary glaucomas). Due to the limited value of the available literature, data on prevalence are unreliable. A 10-year postoperative incidence of 10-25% is given in the literature for developing secondary glaucoma and the frequency increases with the duration of follow-up. A major risk factor seems to be the age at the time of surgery. The younger the patient is at the time of surgery the higher the risk of secondary glaucoma. A microcornea seems to be another risk factor in multivariate analysis. The following postoperative changes might be involved in the pathogenesis: peripheral anterior synechia, high iris insertion and membranous material over the trabecular meshwork. Additionally postoperative inflammation, reaction to lens epithelial cells, perioperative barotrauma and loss of anterior segment architecture might also be responsible. In order to evaluate the optimal age window for congenital cataract surgery and risk factors for the development of secondary glaucoma, a prospective longitudinal study is mandatory.
Collapse
|
49
|
Kim DH, Kim JH, Kim SJ, Yu YS. Long-term results of bilateral congenital cataract treated with early cataract surgery, aphakic glasses and secondary IOL implantation. Acta Ophthalmol 2012; 90:231-6. [PMID: 20819081 DOI: 10.1111/j.1755-3768.2010.01872.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the long-term visual outcome after early surgery of bilateral dense congenital cataracts, aphakic correction with glasses and secondary intraocular lens (IOL) implantation around 2 years of age. METHODS The medical records of paediatric patients who underwent cataract extraction, aphakic correction and secondary IOL implantation from 1993 to 2004 at Seoul National University Children's Hospital were reviewed retrospectively. Age at secondary IOL implantation, axial length (AL), best corrected visual acuity (BCVA), refractive error, ocular alignment, stereopsis, and postoperative ocular complications were recorded. RESULTS Thirty-seven paediatric bilateral pseudophakic patients were identified with a mean follow-up period of 81.4 months. Best corrected visual acuity of 20/40 or better were attained in 44.0% of eyes, and the median BCVA was 20/50. Preoperative factors associated with poor visual prognosis included cataract surgery after 8 weeks of age, interocular AL difference of 0.5 mm or more, and glaucoma. Amblyopic eyes showed more myopic change compared to fellow eyes. Good or moderate binocular function was achieved in 18.9% of all patients. Incidences of strabismus, glaucoma, posterior capsular opacity formation were 46.0%, 32.4% and 4.0%, respectively. CONCLUSION Good postoperative BCVA and binocular function were achieved in most healthy children with bilateral dense congenital cataract and no posterior segment pathology. Early cataract surgery, aphakic correction with glasses and secondary IOL implantation around 2 years of age appears to be appropriate methods.
Collapse
Affiliation(s)
- Dong-Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
50
|
Magli A, Forte R, Rombetto L. Long-term outcome of primary versus secondary intraocular lens implantation after simultaneous removal of bilateral congenital cataract. Graefes Arch Clin Exp Ophthalmol 2012; 251:309-14. [PMID: 22411128 DOI: 10.1007/s00417-012-1979-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/01/2012] [Accepted: 02/20/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Long-term outcomes of intraocular lens (IOL) implantation for congenital cataract in children under 2 years old are still undetermined. METHODS We retrospectively reviewed all cases of bilateral congenital cataract who had undergone simultaneous bilateral cataract removal with posterior capsulotomy and central anterior vitrectomy between 1990 and 2010. Patients randomly underwent primary IOL implantation or secondary IOL implantation after a period of contact lens wear. The two groups were compared for visual outcome and complications during follow-up. RESULTS Cataract removal and primary IOL implantation was performed in 30 eyes (15 patients; nine males, six females) at a mean age of 6.8 ± 4.2 months. After 79.31 ± 63.4 months, best-corrected visual acuity (BCVA) was 0.53 ± 0.36 EDTRS LogMAR. In 36 eyes (18 patients, 11 males, seven females) the lens was removed at a mean age of 5.42 ± 2.80 months, and after 32.0 ± 6.1 months of contact lens utilization, secondary IOL implantation was performed. After 109.0 ± 33.8 months, BCVA was 0.54 ± 0.4 ETDRS LogMAR. The association between age at surgery and final visual acuity and the difference between the two groups concerning type of cataract at baseline, BCVA and refractive error at last visit, incidence of posterior capsular opacification, glaucoma, strabismus, and nystagmus during follow-up were not significant (p > 0.05). Myopic shift was more frequent in eyes undergone primary IOL implantation (p < 0.001). CONCLUSIONS Similar visual outcome and complications were observed during long-term follow-up after both primary and secondary IOL implantation following simultaneous bilateral congenital cataract removal with posterior capsulotomy and central anterior vitrectomy.
Collapse
Affiliation(s)
- Adriano Magli
- Eye Department, University Federico II, Naples, Italy
| | | | | |
Collapse
|