Following congenital cataract removal, patients have an elevated risk of developing glaucoma if they have a family history of congenital cataract, thicker central corneas, smaller horizontal corneal diameters, and thinner lenses, according to a study published in BMC Ophthalmology. Sensitivity to steroid-induced ocular hypertension may also have an association with glaucoma-related adverse events. 

Depending on the follow-up time, individuals who undergo cataract removal as a child can develop postoperative glaucoma between 6% and 58.7% of the time. With such a wide variation in the data, the Childhood Glaucoma Research Network (CGRN) and researchers with the Infant Aphakia Treatment Study (IATS) created a definition for both glaucoma and glaucoma suspect following congenital cataract surgery. They also established factors associated with higher risk of glaucoma-related adverse events. The IATS definition of glaucoma depends on the patient’s IOP rising above 21 mm Hg, plus any 1 of 4 other factors (corneal enlargement, asymmetrical progressive myopic shift coupled with enlargement of the corneal diameter or axial length or both, increased optic nerve cupping defined as an increase of 0.2 or larger cup-to-disc ratio, or if the patient had to undergo a surgical procedure to control IOP). 

The investigators reviewed records from 259 eyes of 174 patients (96 boys, median age at primary surgery 6 months) who underwent congenital cataract surgery between May 2011 and March 2019. Patients were classified into 3 groups: group 1 (n=111 eyes) received primary intraocular lens (IOL) implantation, group 2 (n=85) received secondary IOL implantation, and group 3 (n=63) received no IOL. Researchers also noted patient demographic factors as well as incidence and risk factors for glaucoma-related adverse events.


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In total, glaucoma-related adverse events occurred in 21 (8.1%) eyes. In group 2, 16 eyes (18.8%) developed glaucoma-related adverse events —  5 of them developed open-angle glaucoma, 1 developed angle-closure glaucoma. And 5 eyes (7.9%) in group 3 developed glaucoma-related adverse events — 2 eyes (3.2%) developed angle-closure glaucoma, and 2 (3.2%) developed open-angle glaucoma. None of the group 1 eyes were affected.

However, 5 eyes (4.5%) in group 1, 17 eyes (20.0%) in group 2, and 5 eyes (7.9%) in group 3 developed steroid-induced ocular hypertension. Researchers report that the difference between group 2 and the other groups is statistically significant (all P <.05). 

The researchers also found strong connections between developing glaucoma-related adverse events after congenital cataract surgery and a family history of congenital cataract [hazard ratio (HR), 50.463; 95% CI, 7.051–361.139; P <.001], preoperative central corneal thickness (CCT) [HR, 1.021; 95% CI, 1.009–1.034; P =.001], preoperative horizontal corneal diameter (HCD) [HR, 3.922; 95% CI, 1.558–9.804; P =.004], and preoperative lens thickness (LT) [HR, 3.745; 95% CI, 1.344–10.417; P =.012]. The investigators report that the study was limited by its relatively short follow-up time.

“Regular monitoring of children after cataract surgery with these risk factors may help ophthalmologists detect susceptible individuals and provide timely interventions in the clinic,” investigators report.

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Zhang Z, Fu Y, Wang J, et al. Glaucoma and risk factors three years after congenital cataract surgery. BMC Ophthalmol. Published online March 12, 2022. doi:10.1186/s12886-022-02343-9