Glaucoma Onset Possible Up To 16 Years After Congenital Cataract Surgery

Congenital cataract surgery techniques have greatly advanced in the last two decades, yet complications such as postoperative glaucoma are not as widely investigated — thus, there is scant information available to physicians about the follow-up frequency needed to best manage these pediatric patients. A 37-year longitudinal study shows secondary glaucoma occurring from a few months to 16 years after the procedure, and presents data on visual acuity and risk factors, as reported in Acta Ophthalmologica.

Children in this cohort, born from 1980 to 1997 in Sweden, had diagnoses of congenital cataract and received corrective surgery, most of which were performed at a large university hospital. The investigation examined medical records for 122 eyes of 77 patients followed for an average of 23.2±6.6 years. Researchers divided the sample into 2 subgroups: participants who developed secondary glaucoma, and those who remained free from the complication. 

Glaucoma prevalence totaled 14.8%, with 4.1% displaying early onset, and 10.7% late onset defined as anything after 1 year postoperative. Patients with coexisting microphthalmos were more likely to develop glaucoma than those without (relative risk 7.75, P <.0001). Microphthalmos occurred in 61.5% of late-onset diagnoses, and all “very late-onset” cases. Placement of an intraocular lens (IOL) was also a risk factor (RR 0.31, P =.046), and a modest trend was noted for patients whose age at surgery was younger than 10 days (RR 2.15, P =.14).

Because glaucoma appeared as late as 16 years, the analysis advises long-term check-ups. “Continuous follow-ups are thus necessary to detect these cases early, and special attention needs to be shown to patients with microphthalmos, as they are at a significantly increased risk of developing glaucoma,” the study authors explain, adding that they should be “monitored closely,” as well as those having surgery before 3 months of age more frequently followed.

The researchers speculate IOLs may actually produce a more neutral effect, emphasizing the considerable shift in thought during this study period regarding the best age for an IOL. The participants were previously evaluated at 18 years, with a 12% glaucoma prevalence, and since that time there were additional diagnoses. Other studies have found rates such as 2.2% after 6.5 years of follow-up, 9.9% at 6.7 years, 17% by 4.8 years, or 33.3% after 13.3 years — the longest prior study other than the current group.

Medical records revealed an array of follow-up intervals and information recorded for visual acuity and glaucoma development — thus, the retrospective design limits the study. Also, congenital cataract is rare and Sweden has a small population. Conversely, the multi-year design allowed for a larger population to draw from, allowing clearer patterns to emerge.