The authors undertook a retrospective review of patients with glaucoma after congenital cataract surgery and report clinical presentation, treatment and long-term outcomes at a tertiary referral centre. The study included 58 eyes of 42 patients of which 59% were male. Follow-up was for 55 months. Median age at cataract surgery was 52 days; 94% with bilateral congenital cataract had simultaneous surgery. Nineteen percent had secondary IOL implantation prior to glaucoma diagnosis – median age at surgery was 67 days for cataract surgery and 29 months for secondary IOL implant. Glaucoma diagnosis was after a median elapsed time of 35 months after cataract surgery. Bilateral glaucoma was in 16 patients, and one eye in 26 patients. Most (86%) had open angle glaucoma. Eighty-one percent were aphakic. Glaucoma diagnosis was earlier in aphakic eyes than pesudophakic eyes at 18 and 70 months respectively. Earlier glaucoma diagnosis was associated with eyes with persistent foetal vasculature and aphakia. Mean IOP at diagnosis was 29.1 ±5.6mmHg, median cup:disc ratio was 0.8, 85% received medical treatment at diagnosis and 15% received surgical treatment at diagnosis. Overall, 66% underwent surgery. The most common early complications include severe hypotony and choroidal detachment. Late complications included retinal detachment, endopthalmitis, chronic hypotony and choroidal detachment. Phthisis bulbi was reported in 10.8% and 5.4% underwent evisceration. The authors conclude glaucoma after cataract surgery can be diagnosed at any time with two peaks of diagnosis; in the first year and at year five. Most require surgery to control IOP. The author’s choice is the Ahmed glaucoma valve implant but acknowledge the need for a randomised controlled trial of therapy options. Functional outcomes were better in medically treated eyes.
Glaucoma diagnosis after paediatric cataract surgery
Reviewed by Fiona Rowe
Clinical characteristics and treatment of secondary glaucoma after pediatric congenital cataract surgery in a tertiary referral hospital in Spain.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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