Infantile Cataract Surgery Raises Glaucoma Risk   

Infantile cataract surgery is associated with an increased risk for developing glaucoma, according to research presented at the American Society of Cataract and Refractive Surgery (ASCRS) 2023 Annual Meeting, held in San Diego, California from May 5 to May 8, 2023. Medical treatment is effective for those who develop later onset glaucoma following infantile cataract surgery, according to the report. 

“Reported incidence of glaucoma following cataract surgery varies between 8% to 59%,” according to the report. “Young age at surgery is a major risk factor.”

In this study, researchers Bharti Nihalani-Gangwani, MD, and Deborah K. VanderVeen MD, ABO, conducted a chart review of patients who underwent infantile cataract surgery during a 30-year period at a single center. They analyzed a total of 319 eyes from 212 patients (median age at surgery, 50 days; range, 11-325 days; 107 girls, 105 boys; 105 unilateral procedures) who had at least 1 year of follow up. 

The median follow-up was 8.8 years (range, 1-26.3 years). The study defined glaucoma as intraocular pressure (IOP) greater than 25 mm Hg at 2 consecutive visits with optic nerve head changes.

The researchers explain that 29% of participant eyes (93/319 eyes) developed glaucoma following infantile cataract surgery. In 82% of eyes (76/93 eyes), age at surgery was greater than 3 months (P =.001). Microcornea (44%, P <.0001), poorly dilating pupils (10%, P =.004), persistent fetal vasculature (12%, P =.8) and anterior segment dysgenesis (3%, P =.02) were risk factors associated with glaucoma following cataract surgery.

A total of 76% (19/25) that developed glaucoma within 1 year of infantile cataract surgery required surgical intervention compared with 13% (9/68) who developed glaucoma more than 1 year after surgery (P =.0002). 

Medical treatment was effective in 87% of those who  later developed glaucoma, the report shows. 

Study limitations include its retrospective nature and the single center design.