Younger Pediatric Cataract Surgery Patients At Higher Glaucoma Risk

congenital pyramidal cataract on the left eye
Close-up of a congenital pyramidal cataract on the left eye of a patient under a slit lamp examination. (c) Barraquer Ophthalmological Center, Barcelona
A patient’s age at the time of operation can influence whether they develop glaucomatous disease later in life.

Glaucoma-related adverse events are common among young children with aphakic eyes within 5 years following cataract surgery, according to a study presented at the American Association for Pediatric Ophthalmology and Strabismus 2022 meeting, held in Scottsdale, Arizona, March 23-27. They are especially common among patients in younger age groups, the study suggests. However, that’s not reason enough to delay surgery, explained Michael X. Repka, MD, who co-authored the study. “There’s a tradeoff with vision,” Dr Repka said. “The younger you operate, the better the visual outcomes.”

The research team enrolled children younger than 13 years who were undergoing lens removal into a prospective registry. The team collected data from medical records at enrollment (≤45 days after cataract surgery) and annually thereafter. The cumulative incidence of glaucoma-related adverse events were calculated and the strength of associations of baseline factors with risk of event in multivariable models were evaluated.  

Of the 607 pseudophakic eyes (median age at surgery 5.5 years), the overall cumulative incidence of glaucoma-related adverse events was 7%, while in 427 aphakic eyes (median age at surgery 11.3 months), it was 29%. In aphakic eyes, risk factors associated with glaucoma-related adverse events included younger age (<3 months) at surgery (P <.001), bilateral lensectomy (P =.009), anterior segment abnormalities noted at surgery (P <.001), operative complications (P =.007), and non-White ethnicity (P =.008). 

The report shows that neither sex nor concomitant surgeries at time of lensectomy were associated with glaucoma-related adverse events. The researchers did note that, among pseudophakic eyes, there were no associations between any of these risk factors and glaucoma-related adverse events.  

“Children undergoing lensectomy at any age need ongoing monitoring for the development of glaucoma,” the study explains.

“Earlier surgery has high rates of glaucoma, but better visual outcomes, and later surgery risks poorer vision, but less chance of glaucoma,” Dr Repka said. “Those lines will intersect and there will be an optimum point for surgery. That’s something we’re working on for future research.”


Bothun ED, Repka MX, Kraker RT, et al. Risk of developing glaucoma-related adverse event within five years following pediatric cataract surgery. Paper presented at: The American Association for Pediatric Ophthalmology and Strabismus 2022 Annual Meeting; March 23-27; Scottsdale, AZ. Paper #22.