After Cataract Surgery in Infancy, Patients Require Lifelong Glaucoma Monitoring

A study examined glaucoma-related risks in children who had undergone congenital cataract surgery as infants.

The risk for glaucoma-related adverse events increases during follow-up for pediatric patients who have undergone unilateral cataract removal in infancy, a study shows; however, this disease risk is not influenced by intraocular lens (IOL) implantation. 

While the association between congenital cataract removal and glaucoma has been examined in several studies, including the Infant Aphakia Treatment Study (IATS) ( identifier: NCT00212134), limited data exists about the long-term effects of congenital cataract removal on pediatric patients, explain researchers in the JAMA Ophthalmology-published study. 

The research followed children who had previously participated in IATS for 10 years to assess longer-term effects on the optic nerve head (ONH) and the peripapillary retinal nerve fiber layer (RNFL). 

The study found that IOL implantation played no role in glaucoma-related adverse effects and that the risk of glaucoma-related adverse effects continued to increase with longer follow up intervals. The researchers also discovered that removal of a unilateral congenital cataract was not associated with worse visual acuity outcomes after 10 years. 

The study was designed as a multicenter randomized trial of 114 infants who had undergone unilateral congenital cataract surgery at the age of between 1 and 6 months. Patients were followed at 1 year, 5 years and 10 years after cataract surgery and collected data included measurements of intraocular pressure (IOP), axial length, RNFL, via optical coherence tomography, and ONH photographs. A Kaplan-Meier analysis was then performed to analyze the risk of glaucoma development. 

The results revealed that the risk of developing glaucoma increased with age with a 9% risk at 1 year of age, 17% risk at 5 years of age and 22% risk at 10 years of age. When accounting for patients who were either diagnosed as having glaucoma or as glaucoma suspects, the risk increased to 12% at 1 year, 31% at 5 years and 40% at 10 years. The diagnosis of glaucoma or glaucoma suspect did not have a significant correlation to IOL or aphakic status. 

However, the research notes that eyes with glaucoma had longer axial lengths compared to eyes that were normal or were glaucoma suspect. Likewise, it was noted that RNFL, visual acuity, and ONH appearance in eyes with glaucoma were similar to eyes that were normal or glaucoma suspect. 

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Freedman SF, Beck AD, Nizam A, et al. Glaucoma-related adverse events at 10 years in the infant aphakia treatment study: a secondary analysis of a randomized clinical trialJAMA Ophthalmol. Published online December 17, 2020. doi:10.1001/jamaophthalmol.2020.5664