J Korean Ophthalmol Soc.  2018 Jun;59(6):569-576. 10.3341/jkos.2018.59.6.569.

Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients

• Lee GI
• Han JC
• Kim SB
• Lee EJ
• Kee CW

• KMID: 2413821
• DOI: http://doi.org/10.3341/jkos.2018.59.6.569

Abstract

PURPOSE
To assess the risk of development of secondary glaucoma after congenital cataract surgery using a long-term follow-up study.
METHODS
In total, 148 eyes of 91 patients who underwent congenital cataract surgery at our hospital or other hospitals were included in a retrospective chart review. A diagnosis of secondary glaucoma was made if the intraocular pressure (IOP) exceeded 21 mmHg and the corneal diameter, axial length, or the cup-to-disc ratio increased, or surgery was performed to control the IOP. To analyze the clinical features and risk factors of secondary glaucoma, we evaluated the mean age at cataract surgery, binocularity, presence of a nuclear cataract, methods of cataract surgery, presence of an intraocular lens (IOL), duration of diagnosis of secondary glaucoma after cataract surgery, duration of follow-up, recent best-corrected visual acuity, and refractive errors.
RESULTS
Thirty-five eyes (23.6%) were diagnosed with secondary glaucoma as a complication of congenital cataract surgery. Of these, 11 eyes (31.4%) were treated with glaucoma surgery a mean of 3.4 times. The mean duration from congenital cataract surgery to diagnosis of glaucoma was 112.2 ± 113.1 months. Patients with aphakia had a higher risk of developing secondary glaucoma compared with patients undergoing primary IOL implantation (p = 0.001). Younger age (<3 months at surgery), a nuclear cataract, and aphakia were risk factors for the development of secondary glaucoma (p = 0.03, p = 0.006, and p < 0.001, respectively), and the risk of developing secondary glaucoma increased with secondary IOL implantation (p = 0.052).
CONCLUSIONS
Secondary glaucoma after congenital cataract surgery was more common in patients with secondary IOL implantation, aphakia, a younger age (<3 months), and a nuclear cataract. Patients who underwent congenital cataract surgery had an increased risk for developing secondary glaucoma. Long-term monitoring of the IOP and optic nerve is therefore required for these patients.

Keyword

Aphakia; Congenital cataract surgery; Primary intraocular lens (IOL) implantation; Secondary glaucoma

MeSH Terms

Aphakia
Cataract*
Diagnosis
Follow-Up Studies
Glaucoma*
Humans
Intraocular Pressure
Lenses, Intraocular
Optic Nerve
Refractive Errors
Retrospective Studies
Risk Factors*
Telescopes
Visual Acuity

Figure

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  Figure 1. Kaplan-Meier curves showing cumulative probability of an eye's developing glaucoma or glaucoma suspect after congenital cataract surgery over times. The probability of development glaucoma or glaucoma suspect was estimated to be 38.2 ± 0.1% by 20 years after congenital cataract surgery.

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  Figure 2. Kaplan-Meier curves showing cumulative probability of an eye's developing glaucoma or glaucoma suspect after congenital cataract surgery between each group; primary intraocular lens (IOL) implantation, secondary IOL implantation and aphakia. There were statistical differences of developing glaucoma by logrank test (p < 0.001).

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  Figure 3. Angle photo of a case with secondary glaucoma associated with congenital cataract at the time of glaucoma surgery. Ciliary body band was not visible and scleral spur was partially observed.

Reference

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