Glaucoma in aphakic and pseudophakic eyes following surgery for congenital cataract in the first year of life

Abstract

Purpose: To determine the incidence and risk factors for glaucoma in pseudophakic and aphakic eyes following surgery for congenital cataract within the first year of life.

Methods: We conducted a review of all cataract surgery performed at our unit over a 23-year period. Age at surgery, corneal diameter, intraocular lens implantation, presence of persistent foetal vasculature and visual axis opacification (VAO) were documented. Time to development of glaucoma, management and outcome were determined. One eye was selected randomly for analysis in cases of bilateral cataract.

Results: Duration of follow-up was significantly longer (p < 0.001) in the aphakic (113 +/- 69 months) compared to the pseudophakic group (56 +/- 44 months). Age at surgery was significantly less (p = 0.01) in the aphakic group. The incidence of glaucoma was significantly greater (p = 0.02) in the aphakic (15 eyes, 33%) compared to the pseudophakic (seven eyes, 13%) group. Each eye that developed glaucoma underwent cataract extraction aged < or = 2.5 months. Analysis of all eyes that underwent surgery aged < or = 2.5 months revealed no statistical difference (p = 0.08) in the incidence of glaucoma. Smaller corneal diameter and VAO were not associated with increased risk of glaucoma development. Ahmed valves proved effective in controlling intraocular pressure but visual outcome was poor in the majority of cases.

Conclusion: Surgery for congenital cataract at an early age increases the risk of glaucoma development, regardless of whether the eye is aphakic or pseudophakic. Intraocular pressure control with Ahmed valves is frequently required. Glaucomatous damage and dense amblyopia contribute to poor visual outcome in these eyes.